Healthcare Provider Details

I. General information

NPI: 1881126928
Provider Name (Legal Business Name): PAIN MEDICINE OF YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 JAYCEE DR STE 10
JOHNSTOWN PA
15904
US

IV. Provider business mailing address

1497A S QUEEN ST
YORK PA
17403-3852
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-4055
  • Fax: 814-262-8161
Mailing address:
  • Phone: 717-848-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORENTINA MAYKO
Title or Position: CEO
Credential:
Phone: 814-467-4055