Provider Demographics
NPI:1639492515
Name:EXECUTIVE MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:EXECUTIVE MEDICAL SERVICES PC
Other - Org Name:AFFILIATED PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-935-8725
Mailing Address - Street 1:18 E 48TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1014
Mailing Address - Country:US
Mailing Address - Phone:212-935-8725
Mailing Address - Fax:646-390-2577
Practice Address - Street 1:18 E 48TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1014
Practice Address - Country:US
Practice Address - Phone:212-935-8725
Practice Address - Fax:646-390-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health