Provider Demographics
NPI:1801155130
Name:NEW YORK SPINE CARE MEDICAL, PC
Entity type:Organization
Organization Name:NEW YORK SPINE CARE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:MUSTAFA
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-656-6853
Mailing Address - Street 1:285 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE- LL6
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2978
Mailing Address - Country:US
Mailing Address - Phone:631-656-6853
Mailing Address - Fax:631-656-6855
Practice Address - Street 1:285 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE- LL6
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2978
Practice Address - Country:US
Practice Address - Phone:631-656-6853
Practice Address - Fax:631-656-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2314922081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty