Provider Demographics
NPI:1528357670
Name:UNIVERSITY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHRTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-210-0132
Mailing Address - Street 1:1983 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7036
Mailing Address - Country:US
Mailing Address - Phone:718-866-0510
Mailing Address - Fax:239-210-0134
Practice Address - Street 1:1983 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-7036
Practice Address - Country:US
Practice Address - Phone:718-866-0510
Practice Address - Fax:239-210-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591602Medicaid
NY752011Medicare UPIN