Provider Demographics
NPI:1013208602
Name:MJHS MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:MJHS MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER /EXEC DIR
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTENOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-649-2838
Mailing Address - Street 1:55 WATER ST FL 46
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-3211
Mailing Address - Country:US
Mailing Address - Phone:212-649-5555
Mailing Address - Fax:
Practice Address - Street 1:55 WATER ST FL 46
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10041-3211
Practice Address - Country:US
Practice Address - Phone:212-649-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224025207LH0002X
NY202721207R00000X
NY171229207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty