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General NPI Number Information
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NPI Number | 1952406985
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Entity Type | Organization
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Legal Business Name | PAIN AND REHABILITATION MEDICAL SPECIALISTS, PC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 73 GUY LOMBARDO AVE
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City | FREEPORT
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State | NY
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Zip | 11520-3714
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Country | US
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Telephone | 516-377-3332
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Fax | 516-377-3844
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Provider Business Mailing Address
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Address Line | 73 GUY LOMBARDO AVE
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City | FREEPORT
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State | NY
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Zip | 11520-3714
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Country | US
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Telephone | 516-377-3332
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Fax | 516-377-3844
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN LEDON
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Credential | MD
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Telephone | 516-377-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 244683
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 026755
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 221976
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License Number State | NY
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