Organization
NEW YORK PAIN AND SPINE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JASON MEMPHIS (OFFICE MANAGER)
(646) 535-5989
Entity
Organization
Contact information
Practice address
409 HOOPER RD, ENDWELL, NY 13760-3661
(301) 326-5397
(607) 429-0244
Mailing address
PO BOX 305, VESTAL, NY 13851-0305
(301) 326-5397
(607) 429-0244
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
247295
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02946078
—
NY
01
—
05527502
ECFMG NUMBE
NY
Enumeration date
11/04/2014
Last updated
11/04/2014
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