Provider Demographics
NPI:1366695207
Name:PHILLIPS HILL PAIN MGMT., PC
Entity type:Organization
Organization Name:PHILLIPS HILL PAIN MGMT., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:DISCENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-709-2274
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645
Mailing Address - Country:US
Mailing Address - Phone:845-634-5656
Mailing Address - Fax:845-634-0596
Practice Address - Street 1:100 PHILLIPS HILL RD.
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-634-5656
Practice Address - Fax:845-634-0596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHILLIPS HILL PAIN MGMT., PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140670207R00000X
NJMA045663208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYYZR1OtherNY PTAN
NJ095248OtherNJ PTAN