Provider Demographics
NPI:1437556040
Name:NEW YORK PAIN CONSULTANTS, LLC
Entity Type:Organization
Organization Name:NEW YORK PAIN CONSULTANTS, LLC
Other - Org Name:NATIONAL SPINE AND PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FANDOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-206-1034
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-422-6166
Mailing Address - Fax:
Practice Address - Street 1:8 SAXON AVE STE E
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7036
Practice Address - Country:US
Practice Address - Phone:631-206-1034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6726880004Medicare NSC