Healthcare Provider Details

I. General information

NPI: 1194783704
Provider Name (Legal Business Name): PAULINE LESAGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE EAST BIMC DEPT OF PAIN & PALLIATIVE CARE
NEW YORK NY
10003
US

IV. Provider business mailing address

PO BOX 95000-2435
PHILADELPHIA PA
19195-2435
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-1487
  • Fax:
Mailing address:
  • Phone: 212-844-1499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number213868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: