Provider Demographics
NPI:1083260806
Name:INTEGRATED MUSCULOSKELETAL & SPINE GROUP, PLLC
Entity Type:Organization
Organization Name:INTEGRATED MUSCULOSKELETAL & SPINE GROUP, PLLC
Other - Org Name:THE PAIN GROUP SPECIALIZING IN PAIN MGMT & REHAB MEDICINE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-377-3332
Mailing Address - Street 1:73 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3714
Mailing Address - Country:US
Mailing Address - Phone:516-377-3332
Mailing Address - Fax:516-377-3844
Practice Address - Street 1:73 GUY LOMBARDO AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3714
Practice Address - Country:US
Practice Address - Phone:516-377-3332
Practice Address - Fax:516-377-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty