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General NPI Number Information
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NPI Number | 1508680034
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Entity Type | Organization
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Legal Business Name | HEADACHE INTERVENTION PLLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3825 ASTORIA BLVD
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City | ASTORIA
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State | NY
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Zip | 11103-3608
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Country | US
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Telephone | 816-866-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 21 LODGE RD
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City | GREAT NECK
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State | NY
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Zip | 11021-3927
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Country | US
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Telephone | 816-866-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED COHEN
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Credential | MD
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Telephone | 816-866-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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