Provider Demographics
NPI:1003381146
Name:SPINE AND PAIN CONSULTANT, PLLC
Entity Type:Organization
Organization Name:SPINE AND PAIN CONSULTANT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-667-3577
Mailing Address - Street 1:1360 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1922
Mailing Address - Country:US
Mailing Address - Phone:718-667-3577
Mailing Address - Fax:
Practice Address - Street 1:1 HOLLOW LN STE 102
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1219
Practice Address - Country:US
Practice Address - Phone:516-587-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE AND PAIN CONSULTANT, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-04
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty