Provider Demographics
NPI:1841455854
Name:HOPE MEDICAL OF NEW YORK, PC
Entity type:Organization
Organization Name:HOPE MEDICAL OF NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-1876
Mailing Address - Street 1:2091 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2549
Mailing Address - Country:US
Mailing Address - Phone:718-434-1876
Mailing Address - Fax:347-663-4299
Practice Address - Street 1:2091 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2549
Practice Address - Country:US
Practice Address - Phone:718-434-1876
Practice Address - Fax:347-663-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-20
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03292091Medicaid
NY03292091Medicaid