Provider Demographics
NPI:1124102603
Name:ADVANCED SPINE CARE AND PAIN MANAGEMENT OF NEW YORK PC
Entity type:Organization
Organization Name:ADVANCED SPINE CARE AND PAIN MANAGEMENT OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATHARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-818-4892
Mailing Address - Street 1:565 JEWETT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2654
Mailing Address - Country:US
Mailing Address - Phone:718-701-6010
Mailing Address - Fax:718-447-7831
Practice Address - Street 1:565 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2654
Practice Address - Country:US
Practice Address - Phone:718-701-6010
Practice Address - Fax:718-447-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02006962Medicaid
NY355618300OtherUS DEPT OF LABOR
NY0012J1OtherEMPIRE BC BS
NY205677OtherHIP
NY4C4399OtherPHS/HEALTHNET
NY8799893OtherGHI
NY173446OtherELDERPLAN
NYDA0552OtherRAILROAD MEDICARE
NYP1883750OtherOXFORD
NY0012J1OtherEMPIRE BC BS
NY355618300OtherUS DEPT OF LABOR