NPIMap

Organization Active NPI

Bayside Pain & Rehabilitation Medicine, P.C.

  • Psychiatry Physician
  • Flushing, NY
National Provider Identifier
1356580039
Registry record updated Jun 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
200978 Issued in NY
Legal business name
BAYSIDE PAIN & REHABILITATION MEDICINE, P.C.
Practice address
142-29 37 Ave.
(Basement)
Flushing, NY 11354
Phone
(718) 463-1133
Fax
(718) 463-6392
NPI assigned
Feb 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2009

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

Authorized official

Name
Ki Young Park, M.D.NPI 1346380581
Title
President
Phone
(718) 463-1133

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 200978 NY Primary

Addresses

Primary practice location

142-29 37 Ave.
(Basement)
Flushing, NY 11354

Mailing address

142-29 37 Ave.
(Basement)
Flushing, NY 11354
Phone (718) 463-1133

Other identifiers 1

IdentifierTypeStateIssuer
P-904065OtherNYOXFORD

Other names 1

  • (DBA) Dr. Park's Comprehensive Pain Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

14229 37th Ave
Bsmt
Flushing, NY 11354
Phone (718) 463-1133

Practitioners & affiliated clinicians

Practitioners 2

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": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243900800000",
    "number": "1356580039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142-29 37 AVE.",
            "address_2": "(BASEMENT)",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11354",
            "telephone_number": "718-463-1133",
            "fax_number": "718-463-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142-29 37 AVE.",
            "address_2": "(BASEMENT)",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "11354",
            "telephone_number": "718-463-1133",
            "fax_number": "718-463-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE PAIN & REHABILITATION MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-06-02",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "KI",
        "authorized_official_middle_name": "YOUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-463-1133",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "200978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P-904065",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "(DBA) Dr. Park's Comprehensive Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2009; 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.