Provider Demographics
NPI:1346495900
Name:HUNTINGTON CENTER FOR PAIN TREATMENT, LLP
Entity Type:Organization
Organization Name:HUNTINGTON CENTER FOR PAIN TREATMENT, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TZOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-351-2626
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:
Mailing Address - Fax:
Practice Address - Street 1:775 PARK AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3976
Practice Address - Country:US
Practice Address - Phone:631-351-2626
Practice Address - Fax:631-351-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186571-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF39993Medicare UPIN