Provider Demographics
NPI:1518746478
Name:EMPIRE STATE MEDICAL WELLNESS PC
Entity Type:Organization
Organization Name:EMPIRE STATE MEDICAL WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-644-4707
Mailing Address - Street 1:8215 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5233
Mailing Address - Country:US
Mailing Address - Phone:347-808-2615
Mailing Address - Fax:347-808-2716
Practice Address - Street 1:8215 35TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5233
Practice Address - Country:US
Practice Address - Phone:347-808-2615
Practice Address - Fax:347-808-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty