Roosevelt Ave Pain Medicine PLLC
Pain Medicine, Interventional Pain Medicine in Jackson Heights, NY. Organization (NPI-2).
NPI number1689354565
StatusActive
Last updated in NPPESJul 24, 2023
Details
- NPI
- 1689354565
- Entity type
- Organization (NPI-2)
- Legal business name
- Roosevelt Ave Pain Medicine PLLC
- Organization subpart
- No
- Enumeration date
- Jul 24, 2023
- Certification date
- Jul 24, 2023
- Last updated
- Jul 24, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208VP0014X | Pain Medicine, Interventional Pain Medicine | – | – | Yes |
Practice location
9109 Roosevelt Ave # 201Jackson Heights, NY 11372-7995
Phone 718-433-9293
Mailing address
2152 Ralph Ave # 637Brooklyn, NY 11234-5520
Authorized official
Ashraf K Salem
President/Owner
9299209212
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