Healthcare Provider Details

I. General information

NPI: 1548436124
Provider Name (Legal Business Name): MANHATTAN PAIN MANAGEMENT & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MADISON AVE 13TH FLOOR
NEW YORK NY
10022-1009
US

IV. Provider business mailing address

151 E 80TH ST 2C
NEW YORK NY
10075-0442
US

V. Phone/Fax

Practice location:
  • Phone: 212-588-0980
  • Fax: 212-588-0983
Mailing address:
  • Phone: 212-588-0980
  • Fax: 212-517-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number148023
License Number StateNY

VIII. Authorized Official

Name: HOWARD ADELGLASS
Title or Position: PHYSICAN
Credential: M.D.
Phone: 212-588-0980