Provider Demographics
NPI:1356416085
Name:PHYSICIAN PAIN TREATMENT ASSOCIATES, PC
Entity type:Organization
Organization Name:PHYSICIAN PAIN TREATMENT ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUSKOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-794-3550
Mailing Address - Street 1:30 E 76TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2700
Mailing Address - Country:US
Mailing Address - Phone:212-794-3550
Mailing Address - Fax:212-794-0591
Practice Address - Street 1:30 E 76TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2700
Practice Address - Country:US
Practice Address - Phone:212-794-3550
Practice Address - Fax:212-794-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBKX077102OtherAMERICHOICE
NYMA4116OtherATLANTIS HEALTH PLAN
NY514878POtherHIP
NY6944712OtherCIGNA
NYN97030OtherMULTIPLAN