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General NPI Number Information
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NPI Number | 1275167082
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Entity Type | Organization
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Legal Business Name | YONKERS SPINE MEDICINE PLLC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 1915 CENTRAL PARK AVE STE 205
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City | YONKERS
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State | NY
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Zip | 10710-2949
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Country | US
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Telephone | 914-652-7543
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 CENTRAL PARK AVE STE 205
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City | YONKERS
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State | NY
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Zip | 10710-2949
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Country | US
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Telephone | 914-652-7543
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE/MANAGER
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Name | MICHAEL LACKNER
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Credential | PA
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Telephone | 914-720-7609
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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 |
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License Number State |
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