Provider Demographics
NPI:1073977609
Name:GK MEDICAL PC
Entity Type:Organization
Organization Name:GK MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHELEMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-665-1000
Mailing Address - Street 1:3055 3RD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4857
Mailing Address - Country:US
Mailing Address - Phone:718-665-1000
Mailing Address - Fax:347-577-1030
Practice Address - Street 1:3055 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4857
Practice Address - Country:US
Practice Address - Phone:718-665-1000
Practice Address - Fax:347-577-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty