Provider Demographics
NPI:1184791899
Name:PAIN DOCTOR MEDICAL PLLC
Entity type:Organization
Organization Name:PAIN DOCTOR MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-877-6200
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1367
Mailing Address - Country:US
Mailing Address - Phone:973-989-2644
Mailing Address - Fax:973-989-2645
Practice Address - Street 1:19 W 34TH ST
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-877-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
NY151413-1207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty