Provider Demographics
NPI:1336260595
Name:PAIN AND SPORT MEDICINE OF NEW YORK PC
Entity Type:Organization
Organization Name:PAIN AND SPORT MEDICINE OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-925-8839
Mailing Address - Street 1:32 E 76TH ST APT 804
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2754
Mailing Address - Country:US
Mailing Address - Phone:212-925-8839
Mailing Address - Fax:212-226-8498
Practice Address - Street 1:32 E BROADWAY RM 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6891
Practice Address - Country:US
Practice Address - Phone:212-925-8839
Practice Address - Fax:212-226-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204326174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149219OtherWELLCARE
NY2I2493OtherBLUE CROSS BLUE SHIELD
NYP646923OtherOXFORD
NY10210203OtherAMERIGROUP
NY1888811Medicaid
NY2493590OtherAETNA
NY2493590OtherAETNA