Organization
PAIN MANAGEMENT 360 LLC
Active
Organization
PAIN MANAGEMENT 360 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUDY MALAYIL MD (OWNER)
(917) 645-2591
Entity
Organization
Contact information
Practice address
551 21ST ST, HUNTINGTON, WV 25703-1540
(917) 935-7788
(304) 577-8615
Mailing address
PO BOX 33821, BELFAST, ME 04915-0616
(888) 488-8289
(304) 577-8615
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000210
—
OH
05
—
1821717711
—
WV
05
—
7100858910
—
KY
05
—
7100858920
—
KY
Enumeration date
08/24/2022
Last updated
04/26/2024
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