Provider Demographics
NPI:1407150980
Name:PARK EAST PAIN MANAGEMENT SUITE, PLLC
Entity Type:Organization
Organization Name:PARK EAST PAIN MANAGEMENT SUITE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-667-3577
Mailing Address - Street 1:860 5TH AVE
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5856
Mailing Address - Country:US
Mailing Address - Phone:212-724-7246
Mailing Address - Fax:212-724-7256
Practice Address - Street 1:860 5TH AVE
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5856
Practice Address - Country:US
Practice Address - Phone:212-724-7246
Practice Address - Fax:212-724-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical