MEDICARE: Y A ANESTHESIA PAIN MANAGEMENT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	209053	NY

General Provider Information

NPI Number	:	1104143361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Y A ANESTHESIA PAIN MANAGEMENT PLLC

Provider Business Mailing Address
First Line	:	5 OAKWOOD CT
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-1753
Country	:	US
Telephone Number	:	917-414-0617
Fax Number	:	732-847-3062

Provider Business Practice Location Address
First Line	:	3930 RICHMOND AVE
Second Line	:	SUITE 101
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-5104
Country	:	US
Telephone Number	:	917-414-0617
Fax Number	:	732-847-3062

Authorized Official
Title or Position	:	OWNER
Name	:	YVETTE R ABRAHAM
Credential	:	M.D.
Telephone Number	:	917-414-0617

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	12/08/2014

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