Provider Demographics
NPI:1215022603
Name:PARK MEDICAL ASSOCIATES OF NEW YORK PC
Entity Type:Organization
Organization Name:PARK MEDICAL ASSOCIATES OF NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHELE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SPINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-409-3335
Mailing Address - Street 1:1250 WATERS PL
Mailing Address - Street 2:STE-1207
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2720
Mailing Address - Country:US
Mailing Address - Phone:718-409-3335
Mailing Address - Fax:718-918-9778
Practice Address - Street 1:1250 WATERS PL
Practice Address - Street 2:STE-1207
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2720
Practice Address - Country:US
Practice Address - Phone:718-409-3335
Practice Address - Fax:718-918-9778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW11701Medicare PIN