# 45TH ST PAIN MANAGEMENT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013383835
- **Authorized official:** DR. GARDY D MARCELIN MD (CEO)
- **Authorized official phone:** (561) 469-2635

## Contact information

- **Practice address:** 5642 CORPORATE WAY, WEST PALM BEACH, FL 33407-2002
- **Practice address phone:** (561) 469-2635
- **Practice address fax:** (561) 469-2614
- **Mailing address:** 5642 CORPORATE WAY, WEST PALM BEACH, FL 33407-2002
- **Mailing address phone:** (561) 469-2635
- **Mailing address fax:** (561) 469-2614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | ME97529 | FL | Yes |
| 208VP0000X | Pain Medicine Physician | ME97529 | FL | — |

## Other

- **Enumeration date:** 08/16/2015
- **Last updated:** 08/16/2015