1225444128 NPI number — NEW YORK INTERNAL MEDICINE, 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 1225444128 NPI number — NEW YORK INTERNAL MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK INTERNAL MEDICINE, 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:
1225444128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1752 FRANCIS LEWIS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITESTONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11357-3247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-746-9494
Provider Business Mailing Address Fax Number:
718-746-4963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4604 31ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11103-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-746-9495
Provider Business Practice Location Address Fax Number:
718-746-4963
Provider Enumeration Date:
07/11/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MEEK
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
814-339-7858

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  267642-1 , 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)





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