Healthcare Provider Details

I. General information

NPI: 1255729794
Provider Name (Legal Business Name): NEW YORK PAIN RELIEF MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 SHERBOURNE RD
VALLEY STREAM NY
11580-1829
US

IV. Provider business mailing address

1673 SHERBOURNE RD
VALLEY STREAM NY
11580-1829
US

V. Phone/Fax

Practice location:
  • Phone: 917-724-1886
  • Fax: 347-227-1368
Mailing address:
  • Phone: 917-724-1886
  • Fax: 347-227-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SUELANE DO OURO
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 917-724-1886