Provider Demographics
NPI:1578753554
Name:NEW YORK COLORECTAL CARE LLC
Entity Type:Organization
Organization Name:NEW YORK COLORECTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAFKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-688-2100
Mailing Address - Street 1:133 EAST 58TH STREET
Mailing Address - Street 2:#304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-688-2100
Mailing Address - Fax:212-688-2136
Practice Address - Street 1:133 EAST 58TH STREET
Practice Address - Street 2:#304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-688-2100
Practice Address - Fax:212-688-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1811531261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1886829OtherUNITED HEALTHCARE
NY1578753554OtherNPI
NY000282OtherEMPIRE BLUECROSS BLUESHIE
NY5291622OtherAETNA PPO
NY2004177OtherAETNA MEDICARE HMO
NYP887209OtherOXFORD HEALTH PLANS
NY4699994OtherGHI PPO
NYP00000021264OtherGHI MEDICARE HMO
NY2004177OtherAETNA MEDICARE HMO