Provider Demographics
NPI:1629414982
Name:MEDIKON LLC
Entity Type:Organization
Organization Name:MEDIKON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-250-2956
Mailing Address - Street 1:244 MADISON AVE
Mailing Address - Street 2:#438
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:646-390-9794
Mailing Address - Fax:646-390-9794
Practice Address - Street 1:71 KNAPPS RD
Practice Address - Street 2:
Practice Address - City:STEPHENTOWN
Practice Address - State:NY
Practice Address - Zip Code:12168-2702
Practice Address - Country:US
Practice Address - Phone:917-250-2956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management