Provider Demographics
NPI:1801044821
Name:HEALTH AND ENDURANCE MEDICAL P.C.
Entity Type:Organization
Organization Name:HEALTH AND ENDURANCE MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHLATYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-974-7172
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 5TH ST
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2002
Practice Address - Country:US
Practice Address - Phone:917-974-7172
Practice Address - Fax:201-313-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty