Provider Demographics
NPI:1073652467
Name:PAIN MANAGEMENT OF RICHMOND COUNTY
Entity Type:Organization
Organization Name:PAIN MANAGEMENT OF RICHMOND COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-980-9840
Mailing Address - Street 1:3225 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6703
Mailing Address - Country:US
Mailing Address - Phone:718-980-9840
Mailing Address - Fax:718-980-9843
Practice Address - Street 1:3225 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6703
Practice Address - Country:US
Practice Address - Phone:718-980-9840
Practice Address - Fax:718-980-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY128904261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical