Basic Information
| Provider Information | |||||||||
| NPI: | 1437556040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK PAIN CONSULTANTS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NATIONAL SPINE AND PAIN CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W MAIN ST | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117023027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314226166 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8 SAXON AVE STE E | ||||||||
| Address2: | |||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117067036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312061034 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2014 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | FANDOS | ||||||||
| AuthorizedOfficialFirstName: | LUIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRINCIPAL, DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6312061034 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.