Provider Demographics
NPI:1871771402
Name:ORIGIN PAIN MANAGEMENT AND MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:ORIGIN PAIN MANAGEMENT AND MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GETAHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIFLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-462-1100
Mailing Address - Street 1:110 LEAHY ST
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1618
Mailing Address - Country:US
Mailing Address - Phone:718-462-1100
Mailing Address - Fax:718-462-1900
Practice Address - Street 1:486 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6202
Practice Address - Country:US
Practice Address - Phone:718-462-1100
Practice Address - Fax:718-462-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01909351Medicaid
NYG75534Medicare UPIN