Provider Demographics
NPI:1306279203
Name:BROOKLYN PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:BROOKLYN PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDAYATNIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-302-1111
Mailing Address - Street 1:370 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3176
Mailing Address - Country:US
Mailing Address - Phone:718-302-1111
Mailing Address - Fax:718-506-9702
Practice Address - Street 1:370 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3176
Practice Address - Country:US
Practice Address - Phone:718-302-1111
Practice Address - Fax:718-506-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101301208D00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty