Provider Demographics
NPI:1033391107
Name:EAST COAST PAIN MANAGEMENT P.C.
Entity Type:Organization
Organization Name:EAST COAST PAIN MANAGEMENT P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-297-3200
Mailing Address - Street 1:1207 ROUTE 9 STE 11
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4987
Mailing Address - Country:US
Mailing Address - Phone:845-297-3200
Mailing Address - Fax:845-297-9466
Practice Address - Street 1:1207 ROUTE 9 STE 11
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4987
Practice Address - Country:US
Practice Address - Phone:845-297-3200
Practice Address - Fax:845-297-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189011208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty