Basic Information
| Provider Information | |||||||||
| NPI: | 1225549827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK PAIN CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK RD. | ||||||||
| Address2: | EXECUTIVE PLAZA 1, STE. 501 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103291071 | ||||||||
| FaxNumber: | 4103291071 | ||||||||
| Practice Location | |||||||||
| Address1: | 9151 RUMSEY RD STE 150A | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109102949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2017 | ||||||||
| LastUpdateDate: | 10/23/2017 | ||||||||
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| AuthorizedOfficialLastName: | MILMAN | ||||||||
| AuthorizedOfficialFirstName: | GARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | LABORATORY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4109102949 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247ZC0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Pathology | Clinical Laboratory Director, Non-physician |
No ID Information.