Provider Demographics
NPI:1053864843
Name:ANS MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANS MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EZRA
Authorized Official - Last Name:REITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-663-8561
Mailing Address - Street 1:1801 CENTURY PARK E STE 470
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2306
Mailing Address - Country:US
Mailing Address - Phone:310-663-8561
Mailing Address - Fax:
Practice Address - Street 1:1801 CENTURY PARK E STE 470
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2306
Practice Address - Country:US
Practice Address - Phone:310-663-8561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty