Provider Demographics
NPI:1427100189
Name:PAIN &REHABILITATION MEDICINE, PLLC
Entity type:Organization
Organization Name:PAIN &REHABILITATION MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:VIRMANI
Authorized Official - Last Name:NAMBIAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-470-2005
Mailing Address - Street 1:1 PENN DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8530
Mailing Address - Country:US
Mailing Address - Phone:631-905-7937
Mailing Address - Fax:631-425-2238
Practice Address - Street 1:180 PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1915
Practice Address - Country:US
Practice Address - Phone:631-470-2005
Practice Address - Fax:631-425-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2302232081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0373J1Medicare ID - Type UnspecifiedEMPIRE
NYI01942Medicare UPIN
NY07522GMedicare ID - Type UnspecifiedGHI