Provider Demographics
NPI:1245338573
Name:NYE MEDICAL SERVICES PC
Entity type:Organization
Organization Name:NYE MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-519-1000
Mailing Address - Street 1:1101 PELHAM PKWY N
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5411
Mailing Address - Country:US
Mailing Address - Phone:718-515-3500
Mailing Address - Fax:718-405-3806
Practice Address - Street 1:1101 PELHAM PKWY N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5411
Practice Address - Country:US
Practice Address - Phone:718-515-3500
Practice Address - Fax:718-405-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207L00000X
207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02143722Medicaid
CH2107OtherPALMETTO GBA RRMEDICARE
CH2107OtherPALMETTO GBA RRMEDICARE