| NPI | 1548492226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL GODDARD Administrator 718-858-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 096783) |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology (Licence: NY 185657) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 222545) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 239276) | |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2009-08-14 |