Provider Demographics
NPI:1669417986
Name:ERNST, SY AND MENON PHYSICIANS PC
Entity type:Organization
Organization Name:ERNST, SY AND MENON PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-518-5420
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-1786
Mailing Address - Country:US
Mailing Address - Phone:718-901-8154
Mailing Address - Fax:718-901-8151
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:1770 GRAND CONCOURSE #2G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-518-5581
Practice Address - Fax:718-299-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00491323Medicaid
NYW05751Medicare ID - Type Unspecified