Provider Demographics
NPI:1932499969
Name:BRAIN NERVE & SPINE PLLC
Entity type:Organization
Organization Name:BRAIN NERVE & SPINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-9989
Mailing Address - Street 1:14105 NORTHERN BLVD
Mailing Address - Street 2:STE #1G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4282
Mailing Address - Country:US
Mailing Address - Phone:718-888-9989
Mailing Address - Fax:718-888-9943
Practice Address - Street 1:128 MOTT ST
Practice Address - Street 2:#607
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5540
Practice Address - Country:US
Practice Address - Phone:212-796-7088
Practice Address - Fax:212-796-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LA2200X
NY254514-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063676260OtherNPI