Provider Demographics
NPI:1033137708
Name:PROFESSIONAL PAIN MANAGEMENT P.C.
Entity Type:Organization
Organization Name:PROFESSIONAL PAIN MANAGEMENT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-796-1851
Mailing Address - Street 1:4911 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2819
Mailing Address - Country:US
Mailing Address - Phone:917-238-3871
Mailing Address - Fax:201-796-4080
Practice Address - Street 1:2735 HENRY HUDSON PARKWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-796-1851
Practice Address - Fax:201-796-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138825207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00410242Medicaid
NY00410242Medicaid
NY12A881Medicare ID - Type Unspecified