Provider Demographics
NPI:1508198508
Name:FLUSHING ANESTHESIA PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:FLUSHING ANESTHESIA PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONG
Authorized Official - Middle Name:
Authorized Official - Last Name:HE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-603-3755
Mailing Address - Street 1:13338 41ST RD STE 2N
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3662
Mailing Address - Country:US
Mailing Address - Phone:718-939-5200
Mailing Address - Fax:718-939-5210
Practice Address - Street 1:13338 41ST RD STE 2N
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3662
Practice Address - Country:US
Practice Address - Phone:718-939-5200
Practice Address - Fax:718-939-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201494208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100012917Medicare PIN