Provider Demographics
NPI:1457368052
Name:JEFFREY I. MECHANICK, MD
Entity type:Organization
Organization Name:JEFFREY I. MECHANICK, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MECHANICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-831-2100
Mailing Address - Street 1:1192 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1314
Mailing Address - Country:US
Mailing Address - Phone:212-831-2100
Mailing Address - Fax:212-831-2137
Practice Address - Street 1:1192 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1314
Practice Address - Country:US
Practice Address - Phone:212-831-2100
Practice Address - Fax:212-831-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167522261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty