Healthcare Provider Details

I. General information

NPI: 1447995568
Provider Name (Legal Business Name): NEW YORK NEUROLOGY AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 RICHMOND AVE STE 201
STATEN ISLAND NY
10314-3930
US

IV. Provider business mailing address

1931 RICHMOND AVE STE 201
STATEN ISLAND NY
10314-3930
US

V. Phone/Fax

Practice location:
  • Phone: 718-477-9300
  • Fax: 718-477-9301
Mailing address:
  • Phone: 718-477-9300
  • Fax: 718-477-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHAN NAGENDRA
Title or Position: OWNER
Credential: MD
Phone: 718-477-9300