Provider Demographics
NPI:1447995568
Name:NEW YORK NEUROLOGY AND PAIN MANAGEMENT
Entity type:Organization
Organization Name:NEW YORK NEUROLOGY AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-477-9300
Mailing Address - Street 1:1931 RICHMOND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3930
Mailing Address - Country:US
Mailing Address - Phone:718-477-9300
Mailing Address - Fax:718-477-9301
Practice Address - Street 1:1931 RICHMOND AVE STE 201
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3930
Practice Address - Country:US
Practice Address - Phone:718-477-9300
Practice Address - Fax:718-477-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty