Healthcare Provider Details

I. General information

NPI: 1649222175
Provider Name (Legal Business Name): ADVANCED PAIN CARE MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 OCEAN AVE
BROOKLYN NY
11229-3510
US

IV. Provider business mailing address

2417 OCEAN AVE
BROOKLYN NY
11229-3510
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-2111
  • Fax: 718-332-0180
Mailing address:
  • Phone: 718-332-2111
  • Fax: 718-332-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number225644
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number210710
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number210710
License Number StateNY

VIII. Authorized Official

Name: MICHAEL TRIMBA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-332-2111