Provider Demographics
NPI:1477912822
Name:RICHMOND INTERVENTIONAL PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:RICHMOND INTERVENTIONAL PAIN MANAGEMENT PC
Other - Org Name:RICHMOND INTERVENTIONAL PAIN MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-698-3900
Mailing Address - Street 1:2066 RICHMOND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3961
Mailing Address - Country:US
Mailing Address - Phone:718-698-3900
Mailing Address - Fax:855-564-5600
Practice Address - Street 1:2066 RICHMOND AVE STE 202
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3961
Practice Address - Country:US
Practice Address - Phone:718-698-3900
Practice Address - Fax:855-564-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-14
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty