Provider Demographics
NPI:1457899486
Name:IT TAKES A VILLAGE PAIN MANAGEMENT PRACTICE OF NEW YORK PLLC
Entity Type:Organization
Organization Name:IT TAKES A VILLAGE PAIN MANAGEMENT PRACTICE OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUGI
Authorized Official - Middle Name:
Authorized Official - Last Name:KINYUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-434-1113
Mailing Address - Street 1:132 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-1818
Mailing Address - Country:US
Mailing Address - Phone:312-434-1113
Mailing Address - Fax:
Practice Address - Street 1:518 PLAINVIEW RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5733
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:2017-02-09
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270909207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty