Provider Demographics
NPI:1164660049
Name:PARKWAY PAIN CARE &REHABABILITATION PC
Entity Type:Organization
Organization Name:PARKWAY PAIN CARE &REHABABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIGAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-941-6000
Mailing Address - Street 1:383 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4701
Mailing Address - Country:US
Mailing Address - Phone:718-941-6000
Mailing Address - Fax:718-941-6071
Practice Address - Street 1:383 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4701
Practice Address - Country:US
Practice Address - Phone:718-941-6000
Practice Address - Fax:718-941-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172301332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1047930001Medicare NSC