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General NPI Number Information
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NPI Number | 1538510466
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Entity Type | Organization
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Legal Business Name | SPINE AND PAIN MEDICAL PLLC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 83 MONTGOMERY AVE
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City | SCARSDALE
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State | NY
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Zip | 10583-5104
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Country | US
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Telephone | 914-681-9089
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S BROADWAY SUITE 205
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City | TARRYTOWN
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State | NY
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Zip | 10591-4500
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Country | US
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Telephone | 917-572-7108
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MR. DAE KANG
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Credential |
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Telephone | 914-681-9089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 6143
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License Number State | NY
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