Provider Demographics
NPI:1700578366
Name:SKYLINE SPINE & PAIN MEDICINE PC
Entity Type:Organization
Organization Name:SKYLINE SPINE & PAIN MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-498-8982
Mailing Address - Street 1:2417 JERICHO TPKE # 310
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4710
Mailing Address - Country:US
Mailing Address - Phone:212-498-8982
Mailing Address - Fax:212-208-2519
Practice Address - Street 1:7846 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1957
Practice Address - Country:US
Practice Address - Phone:212-498-8982
Practice Address - Fax:212-208-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty