Provider Demographics
NPI:1316149420
Name:TOWNER MEDICAL PC
Entity type:Organization
Organization Name:TOWNER MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-743-7090
Mailing Address - Street 1:357 E 57TH ST
Mailing Address - Street 2:SUITE 17D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2907
Mailing Address - Country:US
Mailing Address - Phone:718-743-7090
Mailing Address - Fax:718-743-7337
Practice Address - Street 1:7102 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1606
Practice Address - Country:US
Practice Address - Phone:718-743-7090
Practice Address - Fax:718-743-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183466311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71K491Medicare PIN