Provider Demographics
NPI:1407004781
Name:STATEWIDE INTERVENTIONAL PAIN MEDICINE, PC
Entity Type:Organization
Organization Name:STATEWIDE INTERVENTIONAL PAIN MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-739-3862
Mailing Address - Street 1:40 E 2ND ST
Mailing Address - Street 2:P.O. BOX 191
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3504
Mailing Address - Country:US
Mailing Address - Phone:516-739-3862
Mailing Address - Fax:516-747-4783
Practice Address - Street 1:40 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3504
Practice Address - Country:US
Practice Address - Phone:516-739-3862
Practice Address - Fax:516-747-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty