Provider Demographics
NPI:1568571834
Name:SOUTHERN NEW YORK NEUROSURGICAL GROUP
Entity Type:Organization
Organization Name:SOUTHERN NEW YORK NEUROSURGICAL GROUP
Other - Org Name:COMPREHENSIVE PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PAIN SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-748-7468
Mailing Address - Street 1:200 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1559
Mailing Address - Country:US
Mailing Address - Phone:607-748-7468
Mailing Address - Fax:607-754-6130
Practice Address - Street 1:200 FRONT ST
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1559
Practice Address - Country:US
Practice Address - Phone:607-748-7468
Practice Address - Fax:607-754-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01376512Medicaid
NY34664AMedicare PIN