Healthcare Provider Details

I. General information

NPI: 1245256676
Provider Name (Legal Business Name): UPPER EAST SIDE PAIN MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 YORK AVE
NEW YORK NY
10028-5962
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-2683
  • Fax:
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL KREITZER
Title or Position: PRESIDENT
Credential: MD
Phone: 718-204-2683