Provider Demographics
NPI:1629219563
Name:SUNRISE PAIN MEDICINE PLLC
Entity Type:Organization
Organization Name:SUNRISE PAIN MEDICINE PLLC
Other - Org Name:JAYINS I CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PAIN PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUMUGAM
Authorized Official - Middle Name:BALAGAN
Authorized Official - Last Name:JAYARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-796-3700
Mailing Address - Street 1:60 JEFFERSON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1122
Mailing Address - Country:US
Mailing Address - Phone:845-796-3700
Mailing Address - Fax:845-796-3701
Practice Address - Street 1:60 JEFFERSON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1122
Practice Address - Country:US
Practice Address - Phone:845-796-3700
Practice Address - Fax:845-796-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA207279-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1083668321OtherNPIN
NY1629219563OtherNPIN
NYG70936OtherUPIN
NY10158463Medicaid
PA1083668321OtherNPIN