=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578833661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APM SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2012
-----------------------------------------------------
Last Update Date | 01/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 OLD TURNPIKE RD SUITE 205
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-507-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 OLD TURNPIKE RD SUITE 205
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-507-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AMGAD HESSEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-507-0600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 193845
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------