Provider Demographics
NPI: | 1285683102 |
---|---|
Name: | UNIVERSITY GROUP MEDICAL ASSOCIATES, P.C |
Entity Type: | Organization |
Organization Name: | UNIVERSITY GROUP MEDICAL ASSOCIATES, P.C |
Other - Org Name: | CONEY ISLAND MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE VICE PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | JEROME |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 718-616-4820 |
Mailing Address - Street 1: | PO BOX 350251 |
Mailing Address - Street 2: | BAY STREET STATION |
Mailing Address - City: | BROOKLYN |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11235-0251 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-616-4408 |
Mailing Address - Fax: | 718-616-4105 |
Practice Address - Street 1: | 2601 OCEAN PKWY |
Practice Address - Street 2: | BUILDING 6, ROOM 201 |
Practice Address - City: | BROOKLYN |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11235-7745 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-616-4408 |
Practice Address - Fax: | 718-616-4105 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-08 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
Not Answered | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
Not Answered | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
Not Answered | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
Not Answered | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
Not Answered | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
Not Answered | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
Not Answered | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
Not Answered | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
Not Answered | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
Not Answered | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
Not Answered | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
Not Answered | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
Not Answered | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
Not Answered | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |