1124193883 NPI number — PHYSICIAN PAIN TREATMENT ASSOCIATES, PC

Table of content: (NPI 1124193883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124193883 NPI number — PHYSICIAN PAIN TREATMENT ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIAN PAIN TREATMENT ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEW YORK HEADACHE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124193883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
132 ATLANTIC AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11201-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-935-9666
Provider Business Mailing Address Fax Number:
718-935-9667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-935-9666
Provider Business Practice Location Address Fax Number:
718-935-9667
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAUSKOP
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
212-794-3550

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  208981 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33654P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2362189 . This is a "AUSHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MA8981 . This is a "ATLANTIS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 598281 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: H01109 . This is a "GUILD TIMES BENEFIT FUND" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2509192 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1763439 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2362189 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 171319 . This is a "ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3953580002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: H01109 . This is a "DOCTORS CARE NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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