Provider Demographics
NPI:1295845220
Name:NEW YORK PAIN MANAGEMENT GROUP, PLLC
Entity Type:Organization
Organization Name:NEW YORK PAIN MANAGEMENT GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:FRITZ
Authorized Official - Last Name:CEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-554-0997
Mailing Address - Street 1:1400 5TH AVE
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2584
Mailing Address - Country:US
Mailing Address - Phone:646-554-0997
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PL
Practice Address - Street 2:SUITE 508
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2720
Practice Address - Country:US
Practice Address - Phone:888-789-6672
Practice Address - Fax:646-862-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225389208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6160650003Medicare NSC