Provider Demographics
NPI:1144231473
Name:INTERVENTIONAL PAIN MANAGEMENT
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN/CCS-P
Authorized Official - Phone:607-271-9860
Mailing Address - Street 1:601 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2809
Mailing Address - Country:US
Mailing Address - Phone:607-721-9860
Mailing Address - Fax:607-271-9862
Practice Address - Street 1:601 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2809
Practice Address - Country:US
Practice Address - Phone:607-721-9860
Practice Address - Fax:607-271-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177308174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1346Medicare PIN