Provider Demographics
| NPI: | 1639127913 |
|---|---|
| Name: | SLR FPP UNIVERSITY MEDICAL PRACTICE ASSOCIATES |
| Entity type: | Organization |
| Organization Name: | SLR FPP UNIVERSITY MEDICAL PRACTICE ASSOCIATES |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP,OPERATIONS |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | NIGEL |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JOSEPH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 212-315-0144 |
| Mailing Address - Street 1: | 1790 BROADWAY |
| Mailing Address - Street 2: | 3RD FLOOR |
| Mailing Address - City: | NEW YORK |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 10019-1412 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 212-315-0144 |
| Mailing Address - Fax: | 212-315-0196 |
| Practice Address - Street 1: | 1111 AMSTERDAM AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | NEW YORK |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 10025-1716 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 212-315-0144 |
| Practice Address - Fax: | 212-315-0196 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-05 |
| Last Update Date: | 2009-12-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
| No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | 01898631 | Medicaid | |
| NJ | 6995501 | Medicaid | |
| 004725 | Other | ADAERP | |
| NY | 01898631 | Medicaid | |
| NJ | 034283 | Medicare PIN | |
| NJ | 6995501 | Medicaid |
