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General NPI Number Information
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NPI Number | 1619153152
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Entity Type | Organization
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Legal Business Name | MADISON PAIN MANAGEMENT, PC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 1827 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10035-3826
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Country | US
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Telephone | 212-423-4079
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Fax | 201-943-8733
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Provider Business Mailing Address
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Address Line | PO BOX 512553
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City | PHILADELPHIA
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State | PA
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Zip | 19175-2553
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Country | US
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Telephone | 201-943-5991
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Fax | 201-943-8733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE HANLEY
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Credential | MD
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Telephone | 201-943-5991
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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 | 187032
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License Number State | NY
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