# QUEENS MEDICAL PAIN MGMT PC

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

## Provider details

- **NPI number:** 1134202013
- **Authorized official:** SUSAN CAPPADONA (OFFICE MANAGER)
- **Authorized official phone:** (718) 849-8700

## Contact information

- **Practice address:** 8340 WOODHAVEN BOULEVARD, GLENDALE, NY 11385
- **Practice address phone:** (718) 441-0101
- **Practice address fax:** (718) 849-6523
- **Mailing address:** 8340 WOODHAVEN BOULEVARD, GLENDALE, NY 11385
- **Mailing address phone:** (718) 441-0101
- **Mailing address fax:** (718) 849-6523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 08/22/2020