Provider Demographics
NPI:1326229022
Name:ASJS MEDICAL, PLLC
Entity Type:Organization
Organization Name:ASJS MEDICAL, PLLC
Other - Org Name:NY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEVETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-942-2842
Mailing Address - Street 1:1110 PENNSYLVANIA AVE # SF-5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-9003
Mailing Address - Country:US
Mailing Address - Phone:718-272-2272
Mailing Address - Fax:718-272-2273
Practice Address - Street 1:1110 PENNSYLVANIA AVE # SF.5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-9003
Practice Address - Country:US
Practice Address - Phone:718-272-2272
Practice Address - Fax:718-272-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100046342OtherMEDICARE PTAN
NY03307691Medicaid
NY03307691Medicaid