Provider Demographics
NPI:1063554111
Name:MUSEUM MILE OFFICE BASED SURGICAL FACILITY
Entity type:Organization
Organization Name:MUSEUM MILE OFFICE BASED SURGICAL FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:212-535-2300
Mailing Address - Street 1:1016 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0132
Mailing Address - Country:US
Mailing Address - Phone:212-535-2300
Mailing Address - Fax:212-535-0780
Practice Address - Street 1:1016 FIFTH AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0132
Practice Address - Country:US
Practice Address - Phone:212-535-2300
Practice Address - Fax:212-535-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127687261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical