# NEW YORK SPORTS SPINE PAIN MEDICINE P.C.

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

## Provider details

- **NPI number:** 1851072607
- **Authorized official:** SANJEEV AGARWAL MD (PRESIDENT)
- **Authorized official phone:** (347) 920-8375

## Contact information

- **Practice address:** 12620 101ST AVE, JAMAICA, NY 11419-1547
- **Practice address phone:** (718) 322-4145
- **Mailing address:** 1 SHERIDAN RD, SCARSDALE, NY 10583-1524
- **Mailing address phone:** (347) 920-8375

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 07/25/2023
- **Last updated:** 07/25/2023