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General NPI Number Information
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NPI Number | 1073652467
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT OF RICHMOND COUNTY
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3225 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6703
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Country | US
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Telephone | 718-980-9840
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Fax | 718-980-9843
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Provider Business Mailing Address
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Address Line | 3225 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6703
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Country | US
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Telephone | 718-980-9840
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Fax | 718-980-9843
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Authorized Official
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Title or Position | MEDICAL OFFICIER
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Name | BRIAN ANTHONY MALONEY
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Credential | M.D.
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Telephone | 718-980-9840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | NY128904
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License Number State | NY
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