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General NPI Number Information
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NPI Number | 1144604539
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Entity Type | Organization
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Legal Business Name | NEW YORK ISPINE SPECIALIST MEDICAL P.C.
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 600 NORTHERN BLVD
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City | GREAT NECK
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State | NY
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Zip | 11021-5206
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Country | US
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Telephone | 516-441-5739
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Fax |
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Provider Business Mailing Address
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Address Line | 11 HOLIDAY POND RD
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City | JERICHO
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State | NY
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Zip | 11753-1154
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Country | US
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Telephone | 516-441-5739
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Fax |
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Authorized Official
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Title or Position | MD
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Name | MADAN K RAJ
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Credential |
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Telephone | 516-441-5739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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