Provider Demographics
NPI:1093850356
Name:GREATER NEW YORK LITHOTRIPSY, LLC
Entity Type:Organization
Organization Name:GREATER NEW YORK LITHOTRIPSY, LLC
Other - Org Name:NY STONE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-643-9371
Mailing Address - Street 1:142 JORALEMON ST STE 14C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4709
Mailing Address - Country:US
Mailing Address - Phone:718-643-9371
Mailing Address - Fax:
Practice Address - Street 1:339 HICKS ST
Practice Address - Street 2:AT LONG ISLAND COLLEGE HOSPITAL 7TH FLR OTHMER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5509
Practice Address - Country:US
Practice Address - Phone:718-780-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE137987POtherHIP PRISS
NY2500316OtherAETNA HMO
NE7881858OtherAETNA PPO