Provider Demographics
NPI:1649560921
Name:PAIN MANAGEMENT MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENGAMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-724-2168
Mailing Address - Street 1:57-55 HEWLETT STREET
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:718-576-1999
Mailing Address - Fax:718-423-2511
Practice Address - Street 1:7568 187TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1726
Practice Address - Country:US
Practice Address - Phone:718-576-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100068372Medicare PIN