Provider Demographics
NPI:1205222478
Name:METROPOLITAN PAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:METROPOLITAN PAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TZOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-629-4440
Mailing Address - Street 1:PO BOX 4168
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-0779
Mailing Address - Country:US
Mailing Address - Phone:646-556-8980
Mailing Address - Fax:631-629-4772
Practice Address - Street 1:162 E 78TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0406
Practice Address - Country:US
Practice Address - Phone:631-629-4770
Practice Address - Fax:631-629-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA186571-1208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty