Provider Demographics
NPI:1750332128
Name:POMONA PAIN MANAGEMENT
Entity Type:Organization
Organization Name:POMONA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MODEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-354-6700
Mailing Address - Street 1:11 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3559
Mailing Address - Country:US
Mailing Address - Phone:845-354-6700
Mailing Address - Fax:
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:845-354-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0110912111N00000X
NY1487973208100000X, 2081P2900X, 2081S0010X
NY135753261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Not Answered2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Not Answered261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty