1780714485 NPI number — PARK MADISON LABS AT PARKMED

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 1780714485 NPI number — PARK MADISON LABS AT PARKMED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARK MADISON LABS AT PARKMED
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:
6
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:
1780714485
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:
133 E 73RD ST
Provider Second Line Business Mailing Address:
AT PARKMED
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-3556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-628-7900
Provider Business Mailing Address Fax Number:
212-628-7950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 E 73RD ST
Provider Second Line Business Practice Location Address:
AT PARKMED
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-628-7900
Provider Business Practice Location Address Fax Number:
212-628-7950
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DRESSLER
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
212-628-7900

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , 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: 01469429 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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