Provider Demographics
NPI:1427376896
Name:NEW YORK INTERVENTIONAL PAIN MEDICINE SERVICE, PC
Entity Type:Organization
Organization Name:NEW YORK INTERVENTIONAL PAIN MEDICINE SERVICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-633-1249
Mailing Address - Street 1:36 7TH AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6688
Mailing Address - Country:US
Mailing Address - Phone:212-633-1249
Mailing Address - Fax:212-633-2608
Practice Address - Street 1:36 7TH AVE STE 411
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6688
Practice Address - Country:US
Practice Address - Phone:212-633-1249
Practice Address - Fax:212-633-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3402208100000X
5992081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty