Provider Demographics
NPI:1013940444
Name:MUSCULOSKELETAL PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:MUSCULOSKELETAL PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:VASISHTHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-623-8000
Mailing Address - Street 1:257 S MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:845-623-8000
Mailing Address - Fax:845-623-0770
Practice Address - Street 1:257 S MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3360
Practice Address - Country:US
Practice Address - Phone:845-623-8000
Practice Address - Fax:845-623-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231223208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI 12233Medicare UPIN
NYWER 321Medicare ID - Type Unspecified