Provider Demographics
NPI:1104143361
Name:Y A ANESTHESIA PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:Y A ANESTHESIA PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-414-0617
Mailing Address - Street 1:5 OAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1753
Mailing Address - Country:US
Mailing Address - Phone:917-414-0617
Mailing Address - Fax:732-847-3062
Practice Address - Street 1:3930 RICHMOND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-5104
Practice Address - Country:US
Practice Address - Phone:917-414-0617
Practice Address - Fax:732-847-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209053208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18195Medicare PIN
G68764Medicare UPIN