Provider Demographics
NPI:1346775350
Name:HAMILTON MEDICAL PLAZA PC
Entity Type:Organization
Organization Name:HAMILTON MEDICAL PLAZA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:YVES
Authorized Official - Last Name:DASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-215-8280
Mailing Address - Street 1:1865 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-1716
Mailing Address - Country:US
Mailing Address - Phone:718-215-8280
Mailing Address - Fax:718-744-2842
Practice Address - Street 1:820 SAINT ANNS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7885
Practice Address - Country:US
Practice Address - Phone:718-215-8280
Practice Address - Fax:718-744-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)