Healthcare Provider Details

I. General information

NPI: 1306279203
Provider Name (Legal Business Name): BROOKLYN PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BAY RIDGE PKWY
BROOKLYN NY
11209-3176
US

IV. Provider business mailing address

370 BAY RIDGE PKWY
BROOKLYN NY
11209-3176
US

V. Phone/Fax

Practice location:
  • Phone: 718-302-1111
  • Fax: 718-506-9702
Mailing address:
  • Phone: 718-302-1111
  • Fax: 718-506-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number101301
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number101301
License Number StateNY

VIII. Authorized Official

Name: DR. MEHRDAD HEDAYATNIA
Title or Position: OWNER
Credential: MD
Phone: 718-302-1111