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General NPI Number Information
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NPI Number | 1972793206
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Entity Type | Organization
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Legal Business Name | RICHMOND MEDICAL PAIN MANAGEMENT
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 1368 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4303
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Country | US
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Telephone | 718-447-1183
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Fax | 718-447-7252
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Provider Business Mailing Address
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Address Line | 1368 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4303
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Country | US
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Telephone | 718-447-1183
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Fax | 718-447-7252
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Authorized Official
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Title or Position | DOCTOR
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Name | JANICE PAVIS
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Credential | D.O.
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Telephone | 718-447-1183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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