| | Physician Last Name: | Ocean Pain Management & Rehabilitation |
| | Physician First Name: | P.C. |
| | Physician Middle Name: | |
| | Address: | 691 Hugenot Avenue
Staten Island, New York 10312
and
2037 Ocean Avenue
Brooklyn, New York 11230 |
| | License Number: | 171302 |
| | License Type: | |
| | Year of Birth: |
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| | Effective Date: | 05/14/2002 |
| | Action Description for DOH Webpage: | Revocation of certificate of incorporation |
| | Misconduct Description for DOH Webpage: | The corporation admitted to the charge of failing to comply with the requirements of New York State Business Corporation Law Section 1503(a). |
| | License Limitations or Conditions for DOH Webpage: | |
| | Board Order: |
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