1780714204 NPI number — GARY S MEDOWS PC

Table of content: (NPI 1780714204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780714204 NPI number — GARY S MEDOWS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARY S MEDOWS 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:
1780714204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 G GRAND ST
Provider Second Line Business Mailing Address:
SUITE GF
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-260-5990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 G GRAND ST
Provider Second Line Business Practice Location Address:
SUITE GF
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-260-5990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEDOWS
Authorized Official First Name:
GARY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-260-5990

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  098846 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P412791 . This is a "OX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0059117 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C 6307 . This is a "PHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 56411 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: GM08391210 . This is a "BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 098843 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5353537004 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".