Healthcare Provider Details

I. General information

NPI: 1457899486
Provider Name (Legal Business Name): IT TAKES A VILLAGE PAIN MANAGEMENT PRACTICE OF NEW YORK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 PLAINVIEW RD
PLAINVIEW NY
11803-5733
US

IV. Provider business mailing address

132 N 17TH ST
WHEATLEY HEIGHTS NY
11798-1818
US

V. Phone/Fax

Practice location:
  • Phone: 312-434-1113
  • Fax:
Mailing address:
  • Phone: 312-434-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number270909
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. NGUGI KINYUNGU
Title or Position: OWNER
Credential:
Phone: 312-434-1113