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General NPI Number Information
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NPI Number | 1336260595
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Entity Type | Organization
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Legal Business Name | PAIN AND SPORT MEDICINE OF NEW YORK PC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 32 E BROADWAY RM 501
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City | NEW YORK
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State | NY
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Zip | 10002-6891
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Country | US
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Telephone | 212-925-8839
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Fax | 212-226-8498
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Provider Business Mailing Address
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Address Line | 32 E 76TH ST APT 804
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City | NEW YORK
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State | NY
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Zip | 10021-2754
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Country | US
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Telephone | 212-925-8839
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Fax | 212-226-8498
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Authorized Official
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Title or Position | BILLING
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Name | MS. JANE YANG
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Credential |
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Telephone | 212-925-8839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 204326
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License Number State | NY
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