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Organization
INTERVENTIONAL & MULTI-DISCIPLINARY PAIN MANAGEMENT
Active
Organization
INTERVENTIONAL & MULTI-DISCIPLINARY PAIN MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURINE ANN ERMISH RN (OFFICE MANAGER)
(631) 941-0187
Entity
Organization
Contact information
Practice address
2500 NESCONSET HWY, BLDG 24C, STONY BROOK, NY 11790-2555
(631) 444-0910
(631) 689-3814
Mailing address
PO BOX 1523, STONY BROOK, NY 11790-0907
(631) 444-0910
(631) 689-3814
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096933
BLUE CROSS BLUE SHIELD
NY
Enumeration date
05/08/2007
Last updated
08/22/2020
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