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General NPI Number Information
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NPI Number | 1861762601
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Entity Type | Organization
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Legal Business Name | DNA PAIN MANAGEMENT SERVICES- FNP, PC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 02/12/2013
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Provider Practice Location Address
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Address Line | 202 FOSTER AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-2119
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Country | US
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Telephone | 347-837-1005
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Fax | 855-604-7216
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Provider Business Mailing Address
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Address Line | 202 FOSTER AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-2119
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Country | US
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Telephone | 347-837-1005
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Fax | 855-604-7216
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. OMAR DUQMAQ
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Credential | NP
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Telephone | 347-837-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 335423
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License Number State | NY
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