Provider Demographics
NPI:1699376491
Name:UNICO IPA LLC
Entity Type:Organization
Organization Name:UNICO IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYTH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-302-7744
Mailing Address - Street 1:202 CANAL ST # 500
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4517
Mailing Address - Country:US
Mailing Address - Phone:212-965-9888
Mailing Address - Fax:
Practice Address - Street 1:202 CANAL ST # 500
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4517
Practice Address - Country:US
Practice Address - Phone:212-965-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty