Healthcare Provider Details

I. General information

NPI: 1407150980
Provider Name (Legal Business Name): PARK EAST PAIN MANAGEMENT SUITE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2010
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 5TH AVE 1B
NEW YORK NY
10065-5856
US

IV. Provider business mailing address

860 5TH AVE 1B
NEW YORK NY
10065-5856
US

V. Phone/Fax

Practice location:
  • Phone: 212-724-7246
  • Fax: 212-724-7256
Mailing address:
  • Phone: 212-724-7246
  • Fax: 212-724-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH B CHAPMAN
Title or Position: MEMBER
Credential: M.D.
Phone: 718-667-3577