Provider Demographics
NPI: | 1518637891 |
---|---|
Name: | MY MEDICAL PC |
Entity Type: | Organization |
Organization Name: | MY MEDICAL PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | PEYMAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | YOUNESI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 718-709-0940 |
Mailing Address - Street 1: | 612 CORPORATE WAY STE 2M |
Mailing Address - Street 2: | |
Mailing Address - City: | VALLEY COTTAGE |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10989-2027 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 718-280-5436 |
Mailing Address - Fax: | 516-441-6768 |
Practice Address - Street 1: | 612 CORPORATE WAY STE 2M |
Practice Address - Street 2: | |
Practice Address - City: | VALLEY COTTAGE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10989-2027 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-280-5436 |
Practice Address - Fax: | 718-414-1651 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-09-17 |
Last Update Date: | 2022-01-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 227800000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Group - Multi-Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |