Provider Demographics
NPI:1588654636
Name:UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC
Entity Type:Organization
Organization Name:UNIVERSITY ORTHOPEDICS OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TECZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-777-1885
Mailing Address - Street 1:2318 31ST ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2892
Mailing Address - Country:US
Mailing Address - Phone:718-777-1885
Mailing Address - Fax:718-777-9613
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-777-1885
Practice Address - Fax:718-777-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192054207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEN041OtherEMPIRE MEDICARE
NYWEN042OtherEMPIRE MEDICARE
NYWEN042OtherEMPIRE MEDICARE