Provider Demographics
NPI:1013180702
Name:NEW YORK MED GROUP CORP
Entity Type:Organization
Organization Name:NEW YORK MED GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-331-7156
Mailing Address - Street 1:8135 NW 33RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1005
Mailing Address - Country:US
Mailing Address - Phone:786-331-7156
Mailing Address - Fax:
Practice Address - Street 1:8135 NW 33RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1005
Practice Address - Country:US
Practice Address - Phone:786-331-7156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6140550001Medicare NSC