Provider Demographics
NPI:1477898633
Name:PROFESSIONAL MEDICAL HEALTHCARE SERVICE OF NEW YORK, PC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL HEALTHCARE SERVICE OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-323-7963
Mailing Address - Street 1:275 MADISON AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1101
Mailing Address - Country:US
Mailing Address - Phone:800-323-7963
Mailing Address - Fax:718-984-8424
Practice Address - Street 1:275 MADISON AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1101
Practice Address - Country:US
Practice Address - Phone:800-323-7963
Practice Address - Fax:718-984-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254668-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty