Provider Demographics
NPI:1629195938
Name:OZONE PARK MEDICAL DIAGNOSTIC ASSOC. PC
Entity type:Organization
Organization Name:OZONE PARK MEDICAL DIAGNOSTIC ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-835-3800
Mailing Address - Street 1:9510 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2518
Mailing Address - Country:US
Mailing Address - Phone:718-835-3800
Mailing Address - Fax:718-641-3802
Practice Address - Street 1:9510 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2518
Practice Address - Country:US
Practice Address - Phone:718-835-3800
Practice Address - Fax:718-641-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138339207R00000X
NY1207942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty