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General NPI Number Information
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NPI Number | 1144231473
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN MANAGEMENT
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 601 E CHURCH ST
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City | ELMIRA
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State | NY
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Zip | 14901-2809
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Country | US
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Telephone | 607-721-9860
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Fax | 607-271-9862
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Provider Business Mailing Address
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Address Line | 601 E CHURCH ST
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City | ELMIRA
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State | NY
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Zip | 14901-2809
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Country | US
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Telephone | 607-721-9860
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Fax | 607-271-9862
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARY L. FURMAN
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Credential | LPN/CCS-P
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Telephone | 607-271-9860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 177308
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License Number State | NY
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