Healthcare Provider Details

I. General information

NPI: 1629062534
Provider Name (Legal Business Name): PAIN MEDICINE OF YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497A S. QUEEN STREET
YORK PA
17403
US

IV. Provider business mailing address

1497A S. QUEEN STREET
YORK PA
17403
US

V. Phone/Fax

Practice location:
  • Phone: 717-848-3979
  • Fax: 717-668-8967
Mailing address:
  • Phone: 717-848-3979
  • Fax: 717-668-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number160380655
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number160380653
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

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