Provider Demographics
NPI:1023300712
Name:EUGENE NOWAK MD LLP
Entity type:Organization
Organization Name:EUGENE NOWAK MD LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-6693
Mailing Address - Street 1:325 EAST 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-517-6693
Mailing Address - Fax:212-517-6690
Practice Address - Street 1:325 EAST 79TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-517-6693
Practice Address - Fax:212-517-6690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129771208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12144Medicare UPIN
28A501Medicare PIN