45TH St Pain Management LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

ME97529 Issued in FL

Legal business name

45TH ST PAIN MANAGEMENT LLC

Practice address

5642 Corporate Way
West Palm Beach, FL 33407-2002

Phone

(561) 469-2635

Fax

(561) 469-2614

NPI assigned

Aug 16, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gardy D Marcelin, MD

Title

Ceo

Phone

(561) 469-2635

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439683200000",
    "number": "1013383835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5642 CORPORATE WAY",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072002",
            "telephone_number": "561-469-2635",
            "fax_number": "561-469-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5642 CORPORATE WAY",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072002",
            "telephone_number": "561-469-2635",
            "fax_number": "561-469-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "45TH ST PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-16",
        "last_updated": "2015-08-16",
        "status": "A",
        "authorized_official_last_name": "MARCELIN",
        "authorized_official_first_name": "GARDY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-469-2635",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME97529",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "FL",
            "license": "ME97529",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.