Healthcare Provider Details

I. General information

NPI: 1346354370
Provider Name (Legal Business Name): MAIMONIDES PAIN MANAGEMENT FPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

GPO BOX 27633
NEW YORK NY
10087-7633
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN CAMMER
Title or Position: DIRECTOR
Credential:
Phone: 718-283-8773