Provider Demographics
NPI:1881181667
Name:MEN'S MEDICAL NEW YORK, PA
Entity Type:Organization
Organization Name:MEN'S MEDICAL NEW YORK, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-698-1734
Mailing Address - Street 1:6533 LANDINGS CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4078
Mailing Address - Country:US
Mailing Address - Phone:516-698-1734
Mailing Address - Fax:
Practice Address - Street 1:9070 KIMBERLY BLVD STE 48
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2861
Practice Address - Country:US
Practice Address - Phone:516-698-1734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care