MEDICARE: NY INTERVENTIONAL PAIN MEDICINE 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	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1386230951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY INTERVENTIONAL PAIN MEDICINE PLLC

Provider Business Mailing Address
First Line	:	23 ANNETT AVE
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1530
Country	:	US
Telephone Number	:	201-682-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 150TH PL FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4922
Country	:	US
Telephone Number	:	201-682-6811
Fax Number	:	855-443-2544

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JIGNYASA DESAI
Credential	:	DO
Telephone Number	:	201-682-6811

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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