Provider Demographics
NPI:1295764140
Name:ISLAND MEDICAL PAIN MANAGEMENT SERVICES PC
Entity type:Organization
Organization Name:ISLAND MEDICAL PAIN MANAGEMENT SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-764-7246
Mailing Address - Street 1:265 SUNRISE HIGHWAY
Mailing Address - Street 2:UNIT #1 PMB 348
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4912
Mailing Address - Country:US
Mailing Address - Phone:888-877-3850
Mailing Address - Fax:631-329-6951
Practice Address - Street 1:77 N CENTRE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3923
Practice Address - Country:US
Practice Address - Phone:516-764-7246
Practice Address - Fax:516-678-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAZ00799AOtherMDNY
CA7429OtherRAILROAD MEDICARE
NY=========OtherMAGNACARE
CA7429OtherRAILROAD MEDICARE
NYAZ00799AOtherMDNY
NY=========OtherHORIZON
NY=========OtherUNITED HEALTHCARE
NYW99901Medicare PIN