Provider Demographics
NPI:1891820726
Name:MULTI-SPECIALTY PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:MULTI-SPECIALTY PAIN MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAFTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-792-4878
Mailing Address - Street 1:3713 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2054
Mailing Address - Country:US
Mailing Address - Phone:718-792-4878
Mailing Address - Fax:347-851-6756
Practice Address - Street 1:3713 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2054
Practice Address - Country:US
Practice Address - Phone:718-792-4878
Practice Address - Fax:347-851-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203113207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEK031Medicare ID - Type Unspecified
NYG75861Medicare UPIN