Provider Demographics
NPI:1184816340
Name:MEDICAL ASSOCIATES EAST PLLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES EAST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUCKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-570-1800
Mailing Address - Street 1:220 E 69TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5737
Mailing Address - Country:US
Mailing Address - Phone:212-570-1800
Mailing Address - Fax:212-570-1802
Practice Address - Street 1:220 E 69TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5737
Practice Address - Country:US
Practice Address - Phone:212-570-1800
Practice Address - Fax:212-570-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS2357OtherDYF
319481OtherBC/BS
NS2357OtherDYF
NYWAA9010Medicare Oscar/Certification