Provider Demographics
NPI: | 1033153697 |
---|---|
Name: | PHYSICIAN ASSOCIATES OF NYEEI, LLC |
Entity Type: | Organization |
Organization Name: | PHYSICIAN ASSOCIATES OF NYEEI, LLC |
Other - Org Name: | PHYSICIAN ASSOCIATES OF NYEEI, LLC |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DANNY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MUI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 212-979-4200 |
Mailing Address - Street 1: | 310 E 14TH ST |
Mailing Address - Street 2: | 6TH FLOOR |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10003 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-979-4200 |
Mailing Address - Fax: | 212-979-4315 |
Practice Address - Street 1: | 310 EAST 14TH ST. |
Practice Address - Street 2: | 1ST FLOOR |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10003 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-979-4200 |
Practice Address - Fax: | 212-979-4315 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-15 |
Last Update Date: | 2015-11-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 234912 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 02311264 | Medicaid | |
NY | 7M8401 | Medicare ID - Type Unspecified | UKRAINSKY |
NY | W38061 | Medicare ID - Type Unspecified | |
NY | 02311264 | Medicaid | |
NY | 72F011 | Medicare ID - Type Unspecified | SCHANTZ |
NY | 3X3721 | Medicare ID - Type Unspecified | SALIBY |
NY | WU | Medicare ID - Type Unspecified | WU |
NY | 8M1871 | Medicare ID - Type Unspecified | KIM |
NY | 7M4711 | Medicare ID - Type Unspecified | PITMAN |
NY | 34F722 | Medicare ID - Type Unspecified | LINSTROM |
NY | 92V671 | Medicare ID - Type Unspecified | ALEXIADES |
NY | 05A391 | Medicare ID - Type Unspecified | TEITEL,MICHAEL |
NY | 5246N1 | Medicare ID - Type Unspecified | OVCHINSKY |
NY | 917981 | Medicare ID - Type Unspecified | SOLOMON |
NY | 6F0201 | Medicare ID - Type Unspecified | HE |
NY | 7M4711 | Medicare ID - Type Unspecified | PITMAN |
NY | 92V671 | Medicare ID - Type Unspecified | ALEXIADES |
NY | 30N791 | Medicare ID - Type Unspecified | GOULLER |
NY | WU | Medicare ID - Type Unspecified | WU |
NY | 8M1871 | Medicare ID - Type Unspecified | KIM |