Healthcare Provider Details

I. General information

NPI: 1972793206
Provider Name (Legal Business Name): RICHMOND MEDICAL PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 CLOVE RD
STATEN ISLAND NY
10301-4303
US

IV. Provider business mailing address

1368 CLOVE RD
STATEN ISLAND NY
10301-4303
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-1183
  • Fax: 718-447-7252
Mailing address:
  • Phone: 718-447-1183
  • Fax: 718-447-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JANICE PAVIS
Title or Position: DOCTOR
Credential: D.O.
Phone: 718-447-1183