Provider Demographics
NPI:1518219732
Name:HOUSE CALLS MEDICAL GROUP
Entity Type:Organization
Organization Name:HOUSE CALLS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:KORNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:857-383-8177
Mailing Address - Street 1:36 W 9TH ST
Mailing Address - Street 2:APT 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 W 9TH ST
Practice Address - Street 2:APT 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8979
Practice Address - Country:US
Practice Address - Phone:857-383-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY258089OtherNYS LICENSE