1609314210 NPI number — PRECISION PAIN CARE AND REHABILITATION P.C.

Table of content: (NPI 1609314210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609314210 NPI number — PRECISION PAIN CARE AND REHABILITATION P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION PAIN CARE AND REHABILITATION P.C.
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:
Provider Other Organization Name Type Code:
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:
1609314210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 UNION TPKE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-1764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-581-5599
Provider Business Mailing Address Fax Number:
718-880-1374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8611 LEFFERTS BLVD
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11418-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-581-5599
Provider Business Practice Location Address Fax Number:
718-880-1374
Provider Enumeration Date:
02/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CHACKO
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-581-5599

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  256586 , 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)





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