NPIMap

Organization Active NPI

Pain Management & Rehabilitative Physical Medicine, PC

  • Physical Medicine & Rehabilitation Physician
  • Brooklyn, NY
National Provider Identifier
1114061074
Registry record updated Apr 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
166878 Issued in NY
Legal business name
PAIN MANAGEMENT & REHABILITATIVE PHYSICAL MEDICINE, PC
Practice address
2281 82ND St
Brooklyn, NY 11214-2603
Phone
(718) 621-0336
Fax
(718) 621-0339
NPI assigned
Feb 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2014

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

Authorized official

Name
Dr. Laurian Jacoby, MD
Title
President
Phone
(718) 621-0336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X 166878 NY Primary

Addresses

Primary practice location

2281 82ND St
Brooklyn, NY 11214-2603

Mailing address

895 Cherry LN
Valley Stream, NY 11581-2722
Phone (718) 621-0336

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397692800000",
    "number": "1114061074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 CHERRY LN",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115812722",
            "telephone_number": "718-621-0336",
            "fax_number": "718-621-0339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2281 82ND ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112142603",
            "telephone_number": "718-621-0336",
            "fax_number": "718-621-0339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MANAGEMENT & REHABILITATIVE PHYSICAL MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2014-04-17",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "LAURIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-621-0336",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "166878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; 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.