Provider Demographics
NPI:1396842522
Name:NEW YORK SPECIALTY PHYSICIANS, LLP
Entity Type:Organization
Organization Name:NEW YORK SPECIALTY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:ISABELA
Authorized Official - Last Name:WORONIECKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-570-0528
Mailing Address - Street 1:25 GILCHREST RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1404
Mailing Address - Country:US
Mailing Address - Phone:516-570-0528
Mailing Address - Fax:
Practice Address - Street 1:125 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2331
Practice Address - Country:US
Practice Address - Phone:516-570-0528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206320207K00000X
NY2059122080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5N5751OtherMEDICARE NUMBER
NY01711802Medicaid
NY01711811Medicaid
NYI00690Medicare UPIN
NYWLW111Medicare PIN
NYH51947Medicare UPIN