Provider Demographics
NPI:1831718196
Name:CRITICAL CARE MEDICINE SERVICES - NEW YORK, P.C.
Entity type:Organization
Organization Name:CRITICAL CARE MEDICINE SERVICES - NEW YORK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-514-6060
Mailing Address - Street 1:ONE CITYPLACE DRIVE
Mailing Address - Street 2:SUITE 570
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-514-6060
Mailing Address - Fax:866-497-1239
Practice Address - Street 1:747 3RD AVE STE 28B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2803
Practice Address - Country:US
Practice Address - Phone:314-514-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty