Provider Demographics
NPI:1952650269
Name:CHS NY MEDICAL, PC
Entity Type:Organization
Organization Name:CHS NY MEDICAL, PC
Other - Org Name:NEW YORK STOCK EXCHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VM
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-760-0700
Mailing Address - Street 1:10701 PARKRIDGE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 WALL ST
Practice Address - Street 2:9TH FLOOR STE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1905
Practice Address - Country:US
Practice Address - Phone:212-656-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty