Provider Demographics
NPI:1457383762
Name:NEW YORK MEDICAL COLLEGE
Entity type:Organization
Organization Name:NEW YORK MEDICAL COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF AFFILIATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-423-7337
Mailing Address - Street 1:1901 1ST AVE STE 5 SOUTH 2 METROPOLITAN HOSPITAL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7404
Mailing Address - Country:US
Mailing Address - Phone:718-579-6021
Mailing Address - Fax:718-579-6060
Practice Address - Street 1:1901 1ST AVE SUITE 5 SOUTH 2 METROPOLITA
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7404
Practice Address - Country:US
Practice Address - Phone:718-579-6021
Practice Address - Fax:718-579-6060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK MEDICAL COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01002322Medicaid
NYW14041Medicare PIN