Provider Demographics
NPI:1144276742
Name:CROSS RIVER PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:CROSS RIVER PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-226-1776
Mailing Address - Street 1:600C LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1360
Mailing Address - Country:US
Mailing Address - Phone:917-226-1776
Mailing Address - Fax:
Practice Address - Street 1:246 MAIN ST
Practice Address - Street 2:SUITE 15A
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1608
Practice Address - Country:US
Practice Address - Phone:845-255-7200
Practice Address - Fax:845-255-7201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEQ311Medicare ID - Type Unspecified