Healthcare Provider Details

I. General information

NPI: 1134227515
Provider Name (Legal Business Name): MEDICAL PAIN MANAGEMENT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BEEKMAN STREET
NEW YORK NY
10038
US

IV. Provider business mailing address

P.O. BOX 9685
UNIONDALE NY
11555
US

V. Phone/Fax

Practice location:
  • Phone: 212-513-7711
  • Fax: 212-513-7723
Mailing address:
  • Phone: 212-513-7711
  • Fax: 212-513-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. BERNARD LEFF
Title or Position: CEO
Credential:
Phone: 212-513-7711