Provider Demographics
NPI:1023189990
Name:CLARKSTOWN MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CLARKSTOWN MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-352-5900
Mailing Address - Street 1:200 E ECKERSON RD
Mailing Address - Street 2:SUITE 1-6
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7153
Mailing Address - Country:US
Mailing Address - Phone:845-352-5900
Mailing Address - Fax:845-352-1142
Practice Address - Street 1:200 E ECKERSON RD
Practice Address - Street 2:SUITE 1-6
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7153
Practice Address - Country:US
Practice Address - Phone:845-352-5900
Practice Address - Fax:845-352-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW1L531Medicare PIN
NYCN2457Medicare PIN