Provider Demographics
NPI:1265621494
Name:DOUGLAS E MENIKHEIM MD JEFFREY S KALMAN MD & C YIACHOS MD PC
Entity type:Organization
Organization Name:DOUGLAS E MENIKHEIM MD JEFFREY S KALMAN MD & C YIACHOS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-720-5928
Mailing Address - Street 1:129 SLOSSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2522
Mailing Address - Country:US
Mailing Address - Phone:718-720-5928
Mailing Address - Fax:718-720-6706
Practice Address - Street 1:129 SLOSSON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2522
Practice Address - Country:US
Practice Address - Phone:718-720-5928
Practice Address - Fax:718-720-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000327Medicare PIN