Empire State Medical PC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

EMPIRE STATE MEDICAL PC

Practice address

10649 Sutphin Blvd
Jamaica, NY 11435-5135

Phone

(929) 393-1966

Fax

(929) 755-4044

NPI assigned

Nov 29, 2023

Last updated

Nov 29, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel Theagene, M.D.NPI 1518928167

Title

Owner

Phone

(347) 270-8353

Specialties & licenses 1

Addresses

Other names 1

• SAMUEL THEAGENE Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel Michael Theagene, MD

  • Physical Medicine & Rehabilitation Physician
  • Laurelton, NY
  • NPI 1518928167
  NPD (past) Authorized official

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

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1952177057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 120328",
            "city": "SAINT ALBANS",
            "state": "NY",
            "postal_code": "114120328",
            "telephone_number": "347-270-8353",
            "fax_number": "347-826-1917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10649 SUTPHIN BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114355135",
            "telephone_number": "929-393-1966",
            "fax_number": "929-755-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPIRE STATE MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "THEAGENE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "347-270-8353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAMUEL THEAGENE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Keneisha Ennis
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• Interventional Pain Medicine Physician in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Interventional Pain Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; 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.