Provider Demographics
NPI:1386940542
Name:DREISER PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:DREISER PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEIRON
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-843-0900
Mailing Address - Street 1:145 DREISER LOOP
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-2704
Mailing Address - Country:US
Mailing Address - Phone:347-843-0900
Mailing Address - Fax:347-843-0901
Practice Address - Street 1:145 DREISER LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-2704
Practice Address - Country:US
Practice Address - Phone:347-843-0900
Practice Address - Fax:347-843-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1857811261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain