Healthcare Provider Details

I. General information

NPI: 1477792232
Provider Name (Legal Business Name): SPINE AND PAIN CONSULTANT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

IV. Provider business mailing address

1360 HYLAN BLVD
STATEN ISLAND NY
10305-1922
US

V. Phone/Fax

Practice location:
  • Phone: 186-673-5777
  • Fax: 718-351-7151
Mailing address:
  • Phone: 718-667-3577
  • Fax: 718-351-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH B CHAPMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-667-3577