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General NPI Number Information
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NPI Number | 1609518158
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Entity Type | Organization
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Legal Business Name | SEREBNITSKY PAIN MEDICINE, PC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 68 E 131ST ST
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City | NEW YORK
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State | NY
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Zip | 10037-2900
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Country | US
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Telephone | 718-288-7026
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Fax |
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Provider Business Mailing Address
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Address Line | 11201 QUEENS BLVD APT 18G
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City | FOREST HILLS
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State | NY
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Zip | 11375-5592
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Country | US
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Telephone | 718-288-7026
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | STACY SEREBNITSKY
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Credential | MD
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Telephone | 718-288-7026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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