Provider Demographics
NPI:1417373200
Name:DIVISION STREET MEDICAL PC
Entity Type:Organization
Organization Name:DIVISION STREET MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-520-8480
Mailing Address - Street 1:10814 72ND AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7081
Mailing Address - Country:US
Mailing Address - Phone:718-520-8480
Mailing Address - Fax:718-228-8872
Practice Address - Street 1:915 BROADWAY
Practice Address - Street 2:SUITE 1106
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7108
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:718-228-8872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty