Provider Demographics
NPI:1093721383
Name:NEW YORK FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:NEW YORK FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-304-0682
Mailing Address - Street 1:PO BOX 452
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533
Mailing Address - Country:US
Mailing Address - Phone:212-304-0682
Mailing Address - Fax:212-569-1967
Practice Address - Street 1:4960 BROADWAY
Practice Address - Street 2:STE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-304-0682
Practice Address - Fax:212-569-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01861852Medicaid
5D6701Medicare ID - Type Unspecified
NY01861852Medicaid