Provider Demographics
NPI:1386230951
Name:NY INTERVENTIONAL PAIN MEDICINE PLLC
Entity Type:Organization
Organization Name:NY INTERVENTIONAL PAIN MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIGNYASA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-682-6811
Mailing Address - Street 1:23 ANNETT AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1530
Mailing Address - Country:US
Mailing Address - Phone:201-682-6811
Mailing Address - Fax:
Practice Address - Street 1:3518 150TH PL FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4922
Practice Address - Country:US
Practice Address - Phone:201-682-6811
Practice Address - Fax:855-443-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain