Healthcare Provider Details

I. General information

NPI: 1598169948
Provider Name (Legal Business Name): AINSWORTH INSTITUTE OF PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 57TH ST SUITE 1210
NEW YORK NY
10022-2049
US

IV. Provider business mailing address

115 E 57TH ST SUITE 1210
NEW YORK NY
10022-2049
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-2813
  • Fax: 646-607-9061
Mailing address:
  • Phone: 212-203-2813
  • Fax: 646-607-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number256856-1
License Number StateNY

VIII. Authorized Official

Name: COREY W HUNTER
Title or Position: OWNER
Credential: MD
Phone: 212-203-2813