Provider Demographics
NPI:1386790806
Name:PARK EAST MEDICAL PULMONARY MEDICINE AND CRITICAL CARE, P.C.
Entity type:Organization
Organization Name:PARK EAST MEDICAL PULMONARY MEDICINE AND CRITICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:NOUHAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAMAHA
Authorized Official - Suffix:SR
Authorized Official - Credentials:CHIEF EXECUTIVE
Authorized Official - Phone:212-734-4484
Mailing Address - Street 1:230 EAST 52ND STREET
Mailing Address - Street 2:#2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6208
Mailing Address - Country:US
Mailing Address - Phone:212-734-4484
Mailing Address - Fax:212-734-4486
Practice Address - Street 1:54 EAST 82ND STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0305
Practice Address - Country:US
Practice Address - Phone:212-734-4484
Practice Address - Fax:212-734-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205745207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE3422OtherRAILROAD
NYP00286717/DE3422OtherRAILROAD PIN/GRP
NYP00286717/DE3422OtherRAILROAD PIN/GRP
NYWCW521Medicare PIN
NYG58698Medicare UPIN