Provider Demographics
NPI:1720467681
Name:PAIN MANAGEMENT OF STONY BROOK P.C.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT OF STONY BROOK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATZICHRISTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-371-1489
Mailing Address - Street 1:2500 NESCONSET HWY BLDG 24C
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2598
Mailing Address - Country:US
Mailing Address - Phone:631-371-1489
Mailing Address - Fax:631-638-5028
Practice Address - Street 1:2500 NESCONSET HWY BLDG 24C
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2598
Practice Address - Country:US
Practice Address - Phone:631-371-1489
Practice Address - Fax:631-638-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty