=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194818930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KH PAIN ASSOCIATES OF NEW YORK, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 KINGS HWY
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11234-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-951-3072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 270
-----------------------------------------------------
City | MASSAPEQUA PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11762-0270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-264-2035
-----------------------------------------------------
Fax | 631-264-1418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ESWAR DUTT PILLALAMARRI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-951-3072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------