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General NPI Number Information
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NPI Number | 1255797676
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Entity Type | Organization
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Legal Business Name | BAYSIDE PAIN MANAGEMENT
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 115 E 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10022-2049
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Country | US
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Telephone | 212-755-5500
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Fax | 212-755-0505
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Provider Business Mailing Address
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Address Line | 115 E 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10022-2049
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Country | US
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Telephone | 212-755-5500
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Fax | 212-755-0505
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Authorized Official
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Title or Position | CONSULTING AFFILIATE
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Name | DARREN KEITH POLLACK
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Credential | DC
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Telephone | 212-755-5500
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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 | 243366
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License Number State | NY
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