Healthcare Provider Details

I. General information

NPI: 1073652467
Provider Name (Legal Business Name): PAIN MANAGEMENT OF RICHMOND COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 VICTORY BLVD
STATEN ISLAND NY
10314-6703
US

IV. Provider business mailing address

3225 VICTORY BLVD
STATEN ISLAND NY
10314-6703
US

V. Phone/Fax

Practice location:
  • Phone: 718-980-9840
  • Fax: 718-980-9843
Mailing address:
  • Phone: 718-980-9840
  • Fax: 718-980-9843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberNY128904
License Number StateNY

VIII. Authorized Official

Name: BRIAN ANTHONY MALONEY
Title or Position: MEDICAL OFFICIER
Credential: M.D.
Phone: 718-980-9840