Provider Demographics
NPI:1124193883
Name:PHYSICIAN PAIN TREATMENT ASSOCIATES, PC
Entity Type:Organization
Organization Name:PHYSICIAN PAIN TREATMENT ASSOCIATES, PC
Other - Org Name:NEW YORK HEADACHE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUSKOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-794-3550
Mailing Address - Street 1:132 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5502
Mailing Address - Country:US
Mailing Address - Phone:718-935-9666
Mailing Address - Fax:718-935-9667
Practice Address - Street 1:132 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5502
Practice Address - Country:US
Practice Address - Phone:718-935-9666
Practice Address - Fax:718-935-9667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33654POtherHIP
NY2362189OtherAUSHC
NYMA8981OtherATLANTIS HEALTH PLAN
NY598281OtherBLUE CROSS BLUE SHIELD
NYH01109OtherGUILD TIMES BENEFIT FUND
NY2509192OtherGHI
NY1763439OtherFIRST HEALTH
NY2362189OtherAETNA
NY171319OtherELDER PLAN
NY3953580002OtherCIGNA
NYH01109OtherDOCTORS CARE NETWORK
NY=========OtherLOCAL 1199
NYH01109OtherGUILD TIMES BENEFIT FUND
NY3953580002OtherCIGNA
NYH01109OtherDOCTORS CARE NETWORK
NY2362189OtherAETNA
NY=========OtherAMERICA'S HEALTH PLAN
NY=========OtherGALAXY HEALTH NETWORK