Provider Demographics
NPI:1548217029
Name:SEVENTY SECOND STREET MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:SEVENTY SECOND STREET MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-717-7993
Mailing Address - Street 1:310 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4726
Mailing Address - Country:US
Mailing Address - Phone:212-717-7993
Mailing Address - Fax:212-570-5883
Practice Address - Street 1:310 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4726
Practice Address - Country:US
Practice Address - Phone:212-717-7993
Practice Address - Fax:212-570-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6L901Medicare ID - Type Unspecified