Provider Demographics
NPI:1982659751
Name:NEW YORK PAIN MANAGEMENT SERVICES PC
Entity Type:Organization
Organization Name:NEW YORK PAIN MANAGEMENT SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNERIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-858-3335
Mailing Address - Street 1:PO BOX 5170
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5170
Mailing Address - Country:US
Mailing Address - Phone:718-422-5023
Mailing Address - Fax:
Practice Address - Street 1:360 COURT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4353
Practice Address - Country:US
Practice Address - Phone:718-858-3335
Practice Address - Fax:718-858-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2133OtherRAILROAD MEDICARE
DC2133OtherRAILROAD MEDICARE