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General NPI Number Information
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NPI Number | 1104593870
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Entity Type | Organization
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Legal Business Name | KNOX PAIN MANAGEMENT MEDICAL PRACTICE PLLC
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 340 ROUTE 202
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City | SOMERS
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State | NY
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Zip | 10589-3237
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Country | US
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Telephone | 845-254-1155
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Fax | 631-736-1332
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Provider Business Mailing Address
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Address Line | 340 ROUTE 202
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City | SOMERS
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State | NY
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Zip | 10589-3237
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Country | US
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Telephone | 845-254-1155
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Fax | 631-736-1332
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Authorized Official
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Title or Position | OFFICE
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Name | JENNY NEWCOMB
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Credential |
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Telephone | 631-736-4064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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