Provider Demographics
NPI:1194100586
Name:COMPREHENSIVE INTERVENTIONAL PAIN MANAGEMENT, P.C
Entity type:Organization
Organization Name:COMPREHENSIVE INTERVENTIONAL PAIN MANAGEMENT, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWEIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-381-1164
Mailing Address - Street 1:400 ROUTE 211 EAST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COMPREHENSIVE INTERVENTIONAL PAIN MANAGEMENT P.C
Practice Address - Street 2:400 ROUTE 211 EAST SUITE 12
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2123
Practice Address - Country:US
Practice Address - Phone:845-381-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235169207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235169OtherNY LICENSE NUMBER