Provider Demographics
NPI:1366692527
Name:ATLANTIC ANESTHESIA /PAIN MANAGEMENT MEDICAL SERVICES P.C.
Entity Type:Organization
Organization Name:ATLANTIC ANESTHESIA /PAIN MANAGEMENT MEDICAL SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-781-4720
Mailing Address - Street 1:436 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3507
Mailing Address - Country:US
Mailing Address - Phone:212-781-4720
Mailing Address - Fax:212-923-9585
Practice Address - Street 1:436 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3507
Practice Address - Country:US
Practice Address - Phone:212-781-4720
Practice Address - Fax:212-923-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214351207LP2900X
2143512081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty