Provider Demographics
NPI:1275064826
Name:MAINLINE MEDICAL PC
Entity Type:Organization
Organization Name:MAINLINE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-520-8480
Mailing Address - Street 1:10814 72ND AVE
Mailing Address - Street 2:4TH FLR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7081
Mailing Address - Country:US
Mailing Address - Phone:718-520-8480
Mailing Address - Fax:
Practice Address - Street 1:10814 72ND AVE
Practice Address - Street 2:4TH FLR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7081
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty