Provider Demographics
NPI:1124696976
Name:NEW YORK PAIN MEDICINE ASSOCIATE, PLLC
Entity type:Organization
Organization Name:NEW YORK PAIN MEDICINE ASSOCIATE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:HYESUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMESMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:732-873-6868
Mailing Address - Street 1:59 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3579
Mailing Address - Country:US
Mailing Address - Phone:732-873-6868
Mailing Address - Fax:732-862-5523
Practice Address - Street 1:717 FRONT ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4534
Practice Address - Country:US
Practice Address - Phone:732-873-6868
Practice Address - Fax:732-873-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty