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General NPI Number Information
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NPI Number | 1669793394
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PAIN MEDICINE PC
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Dates
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Enumeration Date | 06/16/2010
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 35 SEACOAST TER SUITE 4E
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City | BROOKLYN
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State | NY
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Zip | 11235-6040
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Country | US
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Telephone | 917-885-8851
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Fax |
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Provider Business Mailing Address
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Address Line | 35 SEACOAST TER SUITE 4E
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City | BROOKLYN
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State | NY
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Zip | 11235-6040
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Country | US
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Telephone | 917-885-8851
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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 | DR. ALEXANDER VEDER
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Credential | MD
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Telephone | 917-885-8851
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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 | 207274
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License Number State | NY
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