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General NPI Number Information
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NPI Number | 1164918835
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Entity Type | Organization
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Legal Business Name | INTEGRATED INTERVENTIONAL PAIN MANAGEMENT PC
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 20712 NORTHERN BLVD STE 3
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City | BAYSIDE
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State | NY
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Zip | 11361-3108
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Country | US
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Telephone | 929-400-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 20712 NORTHERN BLVD STE 3
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City | BAYSIDE
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State | NY
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Zip | 11361-3108
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Country | US
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Telephone | 929-400-2542
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARISTIDE BURDUCEA
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Credential | DO
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Telephone | 516-426-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 243366
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License Number State | NY
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