New York Pain and Spine Medicine LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

247295 Issued in NY

Legal business name

NEW YORK PAIN AND SPINE MEDICINE LLC

Practice address

409 Hooper Rd
Endwell, NY 13760-3661

Phone

(301) 326-5397

Fax

(607) 429-0244

NPI assigned

Nov 4, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Jason Memphis

Title

Office Manager

Phone

(646) 535-5989

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1174929012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138510305",
            "telephone_number": "301-326-5397",
            "fax_number": "607-429-0244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 HOOPER RD",
            "city": "ENDWELL",
            "state": "NY",
            "postal_code": "137603661",
            "telephone_number": "301-326-5397",
            "fax_number": "607-429-0244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK PAIN AND SPINE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-04",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "MEMPHIS",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "646-535-5989",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "247295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02946078",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ECFMG NUMBE",
            "identifier": "05527502",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Morrow, PHARM-D
• Hatem Jasim Mukhlis, M.D.
• Barbara Mullen, LCSW-R
• Holly Lynn Mullins, FNP
• Maura Lynn Naro, FNP
• Kara Ann Nunn, M.S. CCC-SLP
• Beverly Ann Ochiai, FNP
• Kimberly Olbrys, LMSW
• John H Oneill, RPA
• Mary Margaret Osick

• Physical Medicine & Rehabilitation Physician in Endwell, NY
• Providers in Endwell, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.