Provider Demographics
NPI:1477563757
Name:EMPIRE JOINT AND SPINE PC
Entity Type:Organization
Organization Name:EMPIRE JOINT AND SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUHAJRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-439-1867
Mailing Address - Street 1:155 E 77TH ST
Mailing Address - Street 2:SUITE 4E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1944
Mailing Address - Country:US
Mailing Address - Phone:212-439-1867
Mailing Address - Fax:
Practice Address - Street 1:9033 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7935
Practice Address - Country:US
Practice Address - Phone:718-457-7000
Practice Address - Fax:718-458-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219978208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02216200Medicaid
NYWES151Medicare ID - Type Unspecified
NY06200GMedicare ID - Type Unspecified
NY02216200Medicaid