1043597263 NPI number — FAMILY MEDICINE NYC P.C.

Table of content: (NPI 1043597263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043597263 NPI number — FAMILY MEDICINE NYC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY MEDICINE NYC P.C.
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:
1043597263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 BAY RIDGE PKWY
Provider Second Line Business Mailing Address:
3A
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11209-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-409-7575
Provider Business Mailing Address Fax Number:
212-720-9037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 1702
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10038-4381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-721-6120
Provider Business Practice Location Address Fax Number:
917-720-9037
Provider Enumeration Date:
11/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GALSTIAN
Authorized Official First Name:
EVA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-409-7575

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  254838 , 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)





Copyright © 2007-2025 www.npivalidator.com