# NEW YORK ISPINE SPECIALIST MEDICAL P.C.

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

## Provider details

- **NPI number:** 1144604539
- **Authorized official:** MADAN K RAJ (MD)
- **Authorized official phone:** (516) 441-5739

## Contact information

- **Practice address:** 600 NORTHERN BLVD, GREAT NECK, NY 11021-5206
- **Practice address phone:** (516) 441-5739
- **Mailing address:** 11 HOLIDAY POND RD, JERICHO, NY 11753-1154
- **Mailing address phone:** (516) 441-5739

## Taxonomy

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

## Other

- **Enumeration date:** 07/15/2015
- **Last updated:** 09/09/2015