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General NPI Number Information
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NPI Number | 1710292651
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Entity Type | Organization
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Legal Business Name | OMNI INTERVENTIONAL PAIN MANAGEMENT, PLLC
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 13620 38TH AVE SUITE 8A
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City | FLUSHING
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State | NY
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Zip | 11354-4233
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Country | US
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Telephone | 917-443-4719
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Fax |
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Provider Business Mailing Address
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Address Line | 13620 38TH AVE SUITE 8A
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City | FLUSHING
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State | NY
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Zip | 11354-4233
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Country | US
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Telephone | 917-443-4719
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DIANE LAM
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Credential | M.D.
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Telephone | 917-443-4719
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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 | 250243
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License Number State | NY
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