Provider Demographics
NPI:1710383971
Name:TREAT MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:TREAT MEDICAL PRACTICE PC
Other - Org Name:GOTOMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYER
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-390-7651
Mailing Address - Street 1:420 LEXINGTON AVE
Mailing Address - Street 2:SUITE 2516
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10170-0002
Mailing Address - Country:US
Mailing Address - Phone:212-874-0107
Mailing Address - Fax:646-304-6474
Practice Address - Street 1:1616 VOORHIES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3914
Practice Address - Country:US
Practice Address - Phone:718-646-1170
Practice Address - Fax:718-646-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153293261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01039041Medicaid
NY01039041Medicaid