Provider Demographics
NPI:1134227515
Name:MEDICAL PAIN MANAGEMENT, P.C.
Entity type:Organization
Organization Name:MEDICAL PAIN MANAGEMENT, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-513-7711
Mailing Address - Street 1:P.O. BOX 9685
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11555
Mailing Address - Country:US
Mailing Address - Phone:212-513-7711
Mailing Address - Fax:212-513-7723
Practice Address - Street 1:19 BEEKMAN STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:212-513-7711
Practice Address - Fax:212-513-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty