Provider Demographics
NPI:1891027967
Name:METROPOLITAN LITHOTRIPTOR ASSOCIATES, PC
Entity Type:Organization
Organization Name:METROPOLITAN LITHOTRIPTOR ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS & CLINICAL QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SABLESAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-742-8801
Mailing Address - Street 1:9825 SPECTRUM DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4930
Mailing Address - Country:US
Mailing Address - Phone:877-465-4845
Mailing Address - Fax:
Practice Address - Street 1:4 OHIO DR STE 101
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1111
Practice Address - Country:US
Practice Address - Phone:516-731-8118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
207L00000X, 208800000X, 261QA1903X, 261QL0400X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWS3142Medicare PIN