MEDICARE: SOUTHEAST PAIN MANAGEMENT LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1780511964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	4770 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-1136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 LINCOLN RD STE 6H-1479
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3020
Country	:	US
Telephone Number	:	718-931-9700
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	SAMUEL KOHN
Credential	:
Telephone Number	:	718-931-9700

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/13/2026

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Directions to “SOUTHEAST PAIN MANAGEMENT LLC ” Practice Location

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