1215022603 NPI number — PARK MEDICAL ASSOCIATES OF NEW YORK PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215022603 NPI number — PARK MEDICAL ASSOCIATES OF NEW YORK PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARK MEDICAL ASSOCIATES OF NEW YORK PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215022603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 WATERS PL
Provider Second Line Business Mailing Address:
STE-1207
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-2720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-409-3335
Provider Business Mailing Address Fax Number:
718-918-9778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 WATERS PL
Provider Second Line Business Practice Location Address:
STE-1207
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-2720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-409-3335
Provider Business Practice Location Address Fax Number:
718-918-9778
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPINOWITZ
Authorized Official First Name:
RACHELE
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
718-409-3335

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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