Provider Demographics
NPI:1275903999
Name:BACK AND BODY MEDICAL
Entity Type:Organization
Organization Name:BACK AND BODY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZILBERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:212-371-2000
Mailing Address - Street 1:133 E 58TH ST STE 708
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1133
Mailing Address - Country:US
Mailing Address - Phone:212-371-2000
Mailing Address - Fax:212-371-2250
Practice Address - Street 1:133 E 58TH ST STE 708
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1133
Practice Address - Country:US
Practice Address - Phone:212-371-2000
Practice Address - Fax:212-371-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002367-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty