Provider Demographics
NPI:1669817938
Name:CORRECTIONAL MEDICAL ASSOCIATES OF NEWYORK, P.C.
Entity Type:Organization
Organization Name:CORRECTIONAL MEDICAL ASSOCIATES OF NEWYORK, P.C.
Other - Org Name:PHS MEDICAL SERVICES, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-774-7015
Mailing Address - Street 1:4904 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1002
Mailing Address - Country:US
Mailing Address - Phone:347-774-7015
Mailing Address - Fax:347-774-8051
Practice Address - Street 1:4904 19TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1002
Practice Address - Country:US
Practice Address - Phone:347-774-7015
Practice Address - Fax:347-774-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No333600000XSuppliersPharmacy