Provider Demographics
NPI:1023440732
Name:IT TAKES A VILLAGE PAIN MANAGEMENT INSTITUTE OF NEW YORK
Entity type:Organization
Organization Name:IT TAKES A VILLAGE PAIN MANAGEMENT INSTITUTE OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGUGI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINYUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-434-1113
Mailing Address - Street 1:2 PATTON PL
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7110 COUNTY ROAD 12 W
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3009
Practice Address - Country:US
Practice Address - Phone:312-434-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270909-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty