MEDICARE: HOLISTIC PAIN 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
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1154474070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC PAIN MEDICINE, PC

Provider Business Mailing Address
First Line	:	343 E 51ST ST
Second Line	:	APT 1D
City	:	NEW YORK
State	:	NY
Zip	:	10022-6756
Country	:	US
Telephone Number	:	646-244-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 65TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4045
Country	:	US
Telephone Number	:	718-336-1500
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. SERGEY ILIYEV
Credential	:	M.D.
Telephone Number	:	646-244-4405

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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