Healthcare Provider Details

I. General information

NPI: 1588183008
Provider Name (Legal Business Name): MMIDDLETOWN INTERVENTIONAL PAIN MANAGEMENT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MIDDLETOWN INTERVENTIONAL PAIN MANAGEMENT, P.C. 400 ROUTE 211 EAST SUITE 12
MIDDLETOWN NY
10940-2123
US

IV. Provider business mailing address

14502 W MEEKER BLVD
SUN CITY WEST AZ
85375-5282
US

V. Phone/Fax

Practice location:
  • Phone: 845-381-1164
  • Fax:
Mailing address:
  • Phone: 623-524-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number235169
License Number StateNY

VIII. Authorized Official

Name: DR. CHINWEIKE IZEOGU
Title or Position: MEDICAL DOCTOR
Credential: M.D
Phone: 845-381-1164