Provider Demographics
NPI:1629157516
Name:MEDICAL PRACTICE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MEDICAL PRACTICE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KITSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-667-7756
Mailing Address - Street 1:235 DONGAN HILLS AVE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-667-7756
Mailing Address - Fax:718-667-7757
Practice Address - Street 1:235 DONGAN HILLS AVENUE
Practice Address - Street 2:SUITE 2E
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-667-7756
Practice Address - Fax:718-667-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NY207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02843396Medicaid
NYWANM11Medicare ID - Type Unspecified
NY02843396Medicaid