Provider Demographics
NPI:1588183008
Name:MMIDDLETOWN INTERVENTIONAL PAIN MANAGEMENT, P.C.
Entity type:Organization
Organization Name:MMIDDLETOWN INTERVENTIONAL PAIN MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINWEIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-381-1164
Mailing Address - Street 1:14502 W MEEKER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5282
Mailing Address - Country:US
Mailing Address - Phone:623-524-8814
Mailing Address - Fax:
Practice Address - Street 1:MIDDLETOWN INTERVENTIONAL PAIN MANAGEMENT, P.C.
Practice Address - Street 2:400 ROUTE 211 EAST SUITE 12
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2123
Practice Address - Country:US
Practice Address - Phone:845-381-1164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235169208VP0014X
207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235169OtherMEDICAL LICENSE NUMBER