MEDICARE: SPINE AND PAIN CONSULTANT, 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1346953270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE AND PAIN CONSULTANT, PLLC

Provider Business Mailing Address
First Line	:	1360 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1922
Country	:	US
Telephone Number	:	718-667-3577
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3913
Country	:	US
Telephone Number	:	718-667-3577
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	KENNETH B CHAPMAN
Credential	:	MD
Telephone Number	:	718-667-3577

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/29/2025

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