New York Pain Management PLLC
Organization Active NPI Pain Medicine (Anesthesiology) Physician · Clifton Park, NY
NPI 1407884455 · NPPES record last updated Sep 9, 2011
Key facts
- NPI
- 1407884455
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pain Medicine (Anesthesiology) Physician 207LP2900X
- Legal business name
- NEW YORK PAIN MANAGEMENT PLLC
- Practice address
- 9 Old Plank Rd
Clifton Park, NY 12065-3107 - Phone
- (518) 371-0777
- NPI assigned
- Jun 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Charles Gordon, MD
- Title
- President
- Phone
- (518) 371-0777
Practitioners 17
-
Elisia Kay Barber, FNP
-
Lynn Collette-Zachar, N.P.
-
Lisa C Rice, FNP
-
Niki Marie Cucchi, FNP
-
Lisa M Greenwald, FNP
-
Quentin Phung, MD
-
Jamie Marie Stahlman, FNP
-
Rachel M Uline, FNP-C
-
Jacqueline Decunzo, ANP
-
Lorina Aiello, NP
-
Blair Lee Ciccarelli, RPA-C
-
Julie Cuneo, NURSE PRACTITIONER
-
Matthew Jordan Dickson, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D1010866 | New York Pain Management PLLC | Certificate of waiver | Mar 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031218000634 | NY | Part B Supplier - Clinic/Group Practice | 8325945199 |
Receives reassigned benefits from 12 practitioners Practice locations: Clifton Park, NY; Queensbury, NY |
| O20241218001419 | NY | DME Supplier - Physician - Interventional Pain Management | 8325945199 | Practice locations: Clifton Park, NY |
National Provider Directory
Locations
9 Old Plank Rd
#100
Clifton Park, NY 12065
Phone (518) 371-0777
9 Old Plank Rd
Clifton Park, NY 12065
Phone (518) 371-0777
1596 Route 9
Halfmoon, NY 12065
Phone 5183716672204
17 Main St
Queensbury, NY 12804
Phone (518) 798-0767
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | Yes |
Addresses
Primary practice location
9 Old Plank Rd
Clifton Park, NY 12065-3107
Mailing address
9 Old Plank Rd
Suite 100
Clifton Park, NY 12065-3107
Phone (518) 283-5418
Other providers in Clifton Park, NY
- Nancy Barbara Ness
- Neurological & Stroke Care PLLC
- Neurology Clifton Park
- New Heights LCSW PLLC
- New York Dialysis Services, Inc
- Patricia Anne Newhall
- Chante Newman
- Patrick Newman
- Newmeadow, Inc.
- Abby Newton
All providers in Clifton Park, NY · Pain Medicine (Anesthesiology) Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.