Provider Demographics
NPI:1639595416
Name:MIDTWON MEDICHAL HEALTH SERVICES PC
Entity Type:Organization
Organization Name:MIDTWON MEDICHAL HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-679-4221
Mailing Address - Street 1:276 5TH AVE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4509
Mailing Address - Country:US
Mailing Address - Phone:212-679-4221
Mailing Address - Fax:212-679-4228
Practice Address - Street 1:276 5TH AVE
Practice Address - Street 2:SUITE 1104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4509
Practice Address - Country:US
Practice Address - Phone:212-679-4221
Practice Address - Fax:212-679-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2149531174400000X
NY035051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty