Provider Demographics
NPI:1710279294
Name:UNIVERSAL MEDICAL OF NYC PC
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL OF NYC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. (MEDICAL DIRECTOR)
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-517-2244
Mailing Address - Street 1:5321 FLATLANDS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-517-2244
Mailing Address - Fax:718-517-2242
Practice Address - Street 1:5321 FLATLANDS AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-517-2244
Practice Address - Fax:718-517-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257837207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty