=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366695207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIPS HILL PAIN MGMT., PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2008
-----------------------------------------------------
Last Update Date | 10/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PHILLIPS HILL RD.
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-634-5656
-----------------------------------------------------
Fax | 845-634-0596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 514
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-634-5656
-----------------------------------------------------
Fax | 845-634-0596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RONALD R DISCENZA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-709-2274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 140670
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | MA045663
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------