Provider Demographics
NPI:1154474070
Name:HOLISTIC PAIN MEDICINE, PC
Entity type:Organization
Organization Name:HOLISTIC PAIN MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ILIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-244-4405
Mailing Address - Street 1:343 E 51ST ST
Mailing Address - Street 2:APT 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6756
Mailing Address - Country:US
Mailing Address - Phone:646-244-4405
Mailing Address - Fax:
Practice Address - Street 1:2333 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4045
Practice Address - Country:US
Practice Address - Phone:718-336-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty