Provider Demographics
NPI:1033267570
Name:PAIN MANAGEMENT OF LONG ISLAND, P.C,
Entity Type:Organization
Organization Name:PAIN MANAGEMENT OF LONG ISLAND, P.C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLPARIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-603-7426
Mailing Address - Street 1:PO BOX 231233
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-0233
Mailing Address - Country:US
Mailing Address - Phone:631-474-2300
Mailing Address - Fax:631-474-2355
Practice Address - Street 1:59 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2628
Practice Address - Country:US
Practice Address - Phone:631-474-2300
Practice Address - Fax:631-474-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192949207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWED331Medicare PIN