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General NPI Number Information
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NPI Number | 1124696976
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Entity Type | Organization
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Legal Business Name | NEW YORK PAIN MEDICINE ASSOCIATE, PLLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 717 FRONT ST
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City | HEMPSTEAD
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State | NY
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Zip | 11550-4534
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Country | US
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Telephone | 732-873-6868
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Fax | 732-873-6869
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Provider Business Mailing Address
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Address Line | 59 VERONICA AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-3579
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Country | US
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Telephone | 732-873-6868
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Fax | 732-862-5523
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Authorized Official
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Title or Position | AUTHORIZED REPRESENTATIVE
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Name | HYESUNG DEMESMIN
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Credential | PHARM.D.
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Telephone | 732-873-6868
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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 |
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License Number State |
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