Provider Demographics
NPI:1568648665
Name:WADSWORTH MEDICAL, PC
Entity Type:Organization
Organization Name:WADSWORTH MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:COMAS ESPINAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-781-5889
Mailing Address - Street 1:129 WADSWORTH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4828
Mailing Address - Country:US
Mailing Address - Phone:212-781-5889
Mailing Address - Fax:212-781-6053
Practice Address - Street 1:129 WADSWORTH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4828
Practice Address - Country:US
Practice Address - Phone:212-781-5889
Practice Address - Fax:212-781-6053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167169208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00966261Medicaid
NY00966261Medicaid
NY00966261Medicaid
NY=========OtherTAX ID