Provider Demographics
NPI:1578852588
Name:105 EAST 78 STREET MEDICAL
Entity Type:Organization
Organization Name:105 EAST 78 STREET MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-3313
Mailing Address - Street 1:885 PARK AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0325
Mailing Address - Country:US
Mailing Address - Phone:212-535-3313
Mailing Address - Fax:212-734-3192
Practice Address - Street 1:885 PARK AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0325
Practice Address - Country:US
Practice Address - Phone:212-535-3313
Practice Address - Fax:212-734-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60112817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty