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General NPI Number Information
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NPI Number | 1366692527
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Entity Type | Organization
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Legal Business Name | ATLANTIC ANESTHESIA /PAIN MANAGEMENT MEDICAL SERVICES P.C.
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 436 FORT WASHINGTON AVE SUITE 1H
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City | NEW YORK
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State | NY
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Zip | 10033-3507
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Country | US
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Telephone | 212-781-4720
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Fax | 212-923-9585
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Provider Business Mailing Address
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Address Line | 436 FORT WASHINGTON AVE SUITE 1H
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City | NEW YORK
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State | NY
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Zip | 10033-3507
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Country | US
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Telephone | 212-781-4720
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Fax | 212-923-9585
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DMITRY MIRONOV
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Credential | MD
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Telephone | 212-781-4720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 214351
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 214351
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License Number State | NY
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