Provider Demographics
NPI:1285871624
Name:NEUROLOGY PAIN TREATMENT OF NY PC
Entity type:Organization
Organization Name:NEUROLOGY PAIN TREATMENT OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-743-7090
Mailing Address - Street 1:15 CEDARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2604
Mailing Address - Country:US
Mailing Address - Phone:201-797-8333
Mailing Address - Fax:
Practice Address - Street 1:225 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3001
Practice Address - Country:US
Practice Address - Phone:718-769-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200226207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG27509Medicare UPIN
NYW33293Medicare PIN