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General NPI Number Information
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NPI Number | 1104143361
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Entity Type | Organization
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Legal Business Name | Y A ANESTHESIA PAIN MANAGEMENT PLLC
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 12/08/2014
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Provider Practice Location Address
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Address Line | 3930 RICHMOND AVE SUITE 101
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5104
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Country | US
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Telephone | 917-414-0617
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Fax | 732-847-3062
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Provider Business Mailing Address
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Address Line | 5 OAKWOOD CT
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City | HOLMDEL
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State | NJ
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Zip | 07733-1753
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Country | US
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Telephone | 917-414-0617
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Fax | 732-847-3062
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Authorized Official
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Title or Position | OWNER
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Name | YVETTE R ABRAHAM
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Credential | M.D.
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Telephone | 917-414-0617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 209053
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License Number State | NY
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