Organization Active NPI

Trinity Pain Management of Staten Island, PLLC

  • Pain Medicine Physician
  • Staten Island, NY
National Provider Identifier
1174912083
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
209053 Issued in NY
Legal business name
TRINITY PAIN MANAGEMENT OF STATEN ISLAND, PLLC
Practice address
3930 Richmond Ave
Suite 101
Staten Island, NY 10312-5104
Phone
(718) 966-1313
NPI assigned
Jan 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2015

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

Authorized official

Name
Yvette Abraham, M.D.
Title
President
Phone
(718) 966-1313

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 209053 NY
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 209053 NY Primary

Addresses

Primary practice location

3930 Richmond Ave
Suite 101
Staten Island, NY 10312-5104

Mailing address

5 Oakwood CT
Holmdel, NJ 07733-1753
Phone (718) 966-1313

National Provider Directory

National Provider Directory

Locations

3930 Richmond Ave
Ste 101
Staten Island, NY 10312
Phone (718) 948-7230

NPI Registry JSON

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1174912083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 OAKWOOD CT",
            "city": "HOLMDEL",
            "state": "NJ",
            "postal_code": "077331753",
            "telephone_number": "718-966-1313",
            "fax_number": "718-966-1360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 RICHMOND AVE",
            "address_2": "SUITE 101",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103125104",
            "telephone_number": "718-966-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY PAIN MANAGEMENT OF STATEN ISLAND, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "ABRAHAM",
        "authorized_official_first_name": "YVETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-966-1313",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "209053",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NY",
            "license": "209053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.