Provider Demographics
NPI:1346399664
Name:WEST PARK MEDICAL GROUP PC
Entity Type:Organization
Organization Name:WEST PARK MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-247-8100
Mailing Address - Street 1:200 W 57TH ST
Mailing Address - Street 2:15TH AND 16TH FLOORS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3211
Mailing Address - Country:US
Mailing Address - Phone:212-247-8100
Mailing Address - Fax:212-247-8093
Practice Address - Street 1:200 W 57TH ST
Practice Address - Street 2:15TH AND 16TH FLOORS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3211
Practice Address - Country:US
Practice Address - Phone:212-247-8100
Practice Address - Fax:212-247-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW30501OtherEMPIRE BC BS
NYW30501OtherEMPIRE BC BS