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General NPI Number Information
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NPI Number | 1467754416
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Entity Type | Organization
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Legal Business Name | SPINE AND SPORTS MEDICINE OF NEW YORK PC
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 820 2ND AVE SUITE 6D
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City | NEW YORK
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State | NY
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Zip | 10017-4504
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Country | US
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Telephone | 212-682-6970
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Fax | 212-682-6979
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Provider Business Mailing Address
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Address Line | 820 2ND AVE SUITE 6D
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City | NEW YORK
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State | NY
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Zip | 10017-4504
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Country | US
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Telephone | 212-682-6970
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Fax | 212-682-6979
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDRE PANAGOS
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Credential | M.D.
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Telephone | 212-682-6970
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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 | A228647-1
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License Number State | NY
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Taxonomy #2
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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 | A220814-1
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License Number State | NY
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