Provider Demographics
NPI:1083080006
Name:HUDSON PAIN ASSOCIATE P C
Entity Type:Organization
Organization Name:HUDSON PAIN ASSOCIATE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-461-5902
Mailing Address - Street 1:13228 41ST AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3628
Mailing Address - Country:US
Mailing Address - Phone:718-461-5902
Mailing Address - Fax:718-461-2009
Practice Address - Street 1:13228 41ST AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3628
Practice Address - Country:US
Practice Address - Phone:718-461-5902
Practice Address - Fax:718-461-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1984401208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty