Provider Demographics
NPI:1295374965
Name:EMERALD CITY MEDICAL PC
Entity Type:Organization
Organization Name:EMERALD CITY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZZINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-983-1370
Mailing Address - Street 1:130 E 40TH ST
Mailing Address - Street 2:STE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0941
Mailing Address - Country:US
Mailing Address - Phone:929-500-1030
Mailing Address - Fax:917-210-3606
Practice Address - Street 1:130 E 40TH ST
Practice Address - Street 2:STE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0941
Practice Address - Country:US
Practice Address - Phone:212-983-1370
Practice Address - Fax:212-286-9327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENRICO FAZZINI, D.O., P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-30
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy