Provider Demographics
NPI:1689809717
Name:ENRIQUE ERGAS M D & THOMAS YOUM M D PC
Entity Type:Organization
Organization Name:ENRIQUE ERGAS M D & THOMAS YOUM M D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ERGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-348-3636
Mailing Address - Street 1:1056 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0112
Mailing Address - Country:US
Mailing Address - Phone:212-348-3636
Mailing Address - Fax:212-410-3338
Practice Address - Street 1:1056 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0112
Practice Address - Country:US
Practice Address - Phone:212-348-3636
Practice Address - Fax:212-410-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW6L861Medicare PIN
NYG100000421Medicare PIN