Provider Demographics
NPI:1952789273
Name:GREAT CITY MEDICAL PC
Entity Type:Organization
Organization Name:GREAT CITY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSYBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-609-8856
Mailing Address - Street 1:68 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2900
Mailing Address - Country:US
Mailing Address - Phone:212-281-8600
Mailing Address - Fax:
Practice Address - Street 1:68 E 131ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-2900
Practice Address - Country:US
Practice Address - Phone:212-281-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253159207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty