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NPI Code Detail

MEDICARE: PAIN MANAGEMENT & REHABILITATIVE PHYSICAL MEDICINE, PC

MEDICARE: PAIN MANAGEMENT & REHABILITATIVE PHYSICAL MEDICINE, PC
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
1208100000XPhysical Medicine & Rehabilitation Physician166878NY

General Provider Information

NPI Number : 1114061074
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAIN MANAGEMENT & REHABILITATIVE PHYSICAL MEDICINE, PC
Provider Business Mailing Address
First Line : 895 CHERRY LN
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11581-2722
Country : US
Telephone Number : 718-621-0336
Fax Number : 718-621-0339
Provider Business Practice Location Address
First Line : 2281 82ND ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11214-2603
Country : US
Telephone Number : 718-621-0336
Fax Number : 718-621-0339
Authorized Official
Title or Position : PRESIDENT
Name : DR. LAURIAN JACOBY
Credential : MD
Telephone Number : 718-621-0336
Provider Enumeration Date : 02/16/2007
Last Update Date : 04/17/2014

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Directions to “PAIN MANAGEMENT & REHABILITATIVE PHYSICAL MEDICINE, PC ” Practice Location

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