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General NPI Number Information
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NPI Number | 1164865911
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Entity Type | Organization
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Legal Business Name | THE SPINE AND PAIN INSTITUTE OF NEW YORK
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 1534 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3548
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Country | US
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Telephone | 718-667-3577
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Fax |
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Provider Business Mailing Address
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Address Line | 1534 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3548
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Country | US
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Telephone | 718-667-3577
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. IRINA DYNOV
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Credential | FNP
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Telephone | 718-667-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 33337627
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License Number State | NY
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