Healthcare Provider Details

I. General information

NPI: 1255067278
Provider Name (Legal Business Name): NYSPINECARE, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 25TH ST FL 6
NEW YORK NY
10010-8207
US

IV. Provider business mailing address

51 E 25TH ST FL 6
NEW YORK NY
10010-8207
US

V. Phone/Fax

Practice location:
  • Phone: 212-813-3632
  • Fax: 212-696-0106
Mailing address:
  • Phone: 212-813-3632
  • Fax: 212-696-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL-MARIE JEROME BRISSON
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 212-813-3632