Provider Demographics
NPI:1396816963
Name:MEDICAL PAIN CONSULTANTS,INC
Entity Type:Organization
Organization Name:MEDICAL PAIN CONSULTANTS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:607-844-9979
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-0640
Mailing Address - Country:US
Mailing Address - Phone:607-844-9979
Mailing Address - Fax:607-844-9066
Practice Address - Street 1:2127 DRYDEN RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9611
Practice Address - Country:US
Practice Address - Phone:607-844-9979
Practice Address - Fax:607-844-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225765208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365795Medicaid
NYH76153Medicare UPIN
NYAA1448Medicare ID - Type Unspecified