Basic Information
| Provider Information | |||||||||
| NPI: | 1790007193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GALLERIA PAIN MANAGEMENT SUITE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 E 57TH ST | ||||||||
| Address2: | STE 610 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100222049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125353505 | ||||||||
| FaxNumber: | 2125353568 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 E 57TH ST | ||||||||
| Address2: | STE 610 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100222049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125353505 | ||||||||
| FaxNumber: | 2125353568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2010 | ||||||||
| LastUpdateDate: | 02/25/2010 | ||||||||
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| AuthorizedOfficialLastName: | BAKSHI | ||||||||
| AuthorizedOfficialFirstName: | SANJAY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2125353505 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | 195930 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.