Provider Demographics
NPI:1598794430
Name:METROPOLITAN LITHOTRIPTOR ASSOCIATES, PC
Entity Type:Organization
Organization Name:METROPOLITAN LITHOTRIPTOR ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-742-8802
Mailing Address - Street 1:205 LEXINGTON AVENUE
Mailing Address - Street 2:FLOOR 15
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:646-742-8800
Mailing Address - Fax:646-742-8850
Practice Address - Street 1:176-60 UNION TURNPIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366
Practice Address - Country:US
Practice Address - Phone:646-742-8800
Practice Address - Fax:646-742-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ANC144OtherOXFORD
IC7854OtherHEALTHNET
293999OtherUNITED HEALTH CARE
346777374OtherVYTRA
97003OtherCIGNA
NYAZ00256Medicaid
1000332OtherGHI
8459536OtherAETNA
001151OtherHORIZON