MEDICARE: RADIUS 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	211953	NY

General Provider Information

NPI Number	:	1699293415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIUS PAIN MANAGEMENT PLLC

Provider Business Mailing Address
First Line	:	201 MONTGOMERY ST APT 263
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-5057
Country	:	US
Telephone Number	:	929-200-1137
Fax Number	:	646-304-1681

Provider Business Practice Location Address
First Line	:	201 MONTGOMERY ST APT 263
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-5057
Country	:	US
Telephone Number	:	929-200-1137
Fax Number	:	646-304-1681

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HAROON CHAUDHRY
Credential	:	MD
Telephone Number	:	929-200-1137

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	04/13/2021

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