Provider Demographics
NPI:1013528363
Name:OPHELIA MEDICAL GROUP NY, P.C.
Entity Type:Organization
Organization Name:OPHELIA MEDICAL GROUP NY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:267-984-1732
Mailing Address - Street 1:228 PARK AVE S STE 15314
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1502
Mailing Address - Country:US
Mailing Address - Phone:152-585-2144
Mailing Address - Fax:267-780-7032
Practice Address - Street 1:228 PARK AVE S STE 15314
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1502
Practice Address - Country:US
Practice Address - Phone:152-585-2144
Practice Address - Fax:267-780-7032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty