Provider Demographics
NPI:1487978482
Name:SPINAL PAIN &REHAB MEDICAL PC
Entity type:Organization
Organization Name:SPINAL PAIN &REHAB MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-705-6788
Mailing Address - Street 1:159 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2232
Mailing Address - Country:US
Mailing Address - Phone:917-705-6788
Mailing Address - Fax:914-207-1162
Practice Address - Street 1:455 CENTRAL PARK AVE
Practice Address - Street 2:NUMBER 311
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1060
Practice Address - Country:US
Practice Address - Phone:914-207-1161
Practice Address - Fax:914-207-1162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249489-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty