Provider Demographics
NPI:1770832156
Name:MEDICAL ONE NEW YORK, PC
Entity Type:Organization
Organization Name:MEDICAL ONE NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-490-5475
Mailing Address - Street 1:20 EAST 46TH ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9249
Mailing Address - Country:US
Mailing Address - Phone:646-490-5475
Mailing Address - Fax:646-559-4673
Practice Address - Street 1:20 EAST 46TH STREET
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9249
Practice Address - Country:US
Practice Address - Phone:646-490-5475
Practice Address - Fax:646-559-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4592OtherAAAASF