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General NPI Number Information
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NPI Number | 1235484726
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Entity Type | Organization
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Legal Business Name | NEW YORK INTERVENTIONAL SPINE AND PAIN MEDICINE PC
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 405 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-3315
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Country | US
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Telephone | 646-732-7139
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Fax | 718-768-7303
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Provider Business Mailing Address
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Address Line | 405 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-3315
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Country | US
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Telephone | 646-732-7139
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Fax | 718-768-7303
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABDULQUADER KHAN
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Credential | MD
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Telephone | 646-732-7139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 251646
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 000135
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 003681
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 251646
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License Number State | NY
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