Healthcare Provider Details

I. General information

NPI: 1518110949
Provider Name (Legal Business Name): KRISTOFFER GUY PADJEN MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 38TH ST 14TH FLOOR
NEW YORK NY
10016-2708
US

IV. Provider business mailing address

112 PERSIMMON LN
HOLMDEL NJ
07733-2769
US

V. Phone/Fax

Practice location:
  • Phone: 212-201-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number265152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: