Provider Demographics
NPI:1013173541
Name:HARLEM MEDICAL CARE P.C.
Entity Type:Organization
Organization Name:HARLEM MEDICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-907-2983
Mailing Address - Street 1:2860 OCEAN AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3166
Mailing Address - Country:US
Mailing Address - Phone:718-753-2223
Mailing Address - Fax:718-872-7509
Practice Address - Street 1:2860 OCEAN AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3166
Practice Address - Country:US
Practice Address - Phone:718-753-2223
Practice Address - Fax:718-872-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236807-1174400000X
NY236807207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694448Medicaid
NY02694448Medicaid
NY825C01Medicare PIN
NY02694448Medicaid