Provider Demographics
NPI:1396901468
Name:CENTRAL PARK MEDICAL PRACTICE
Entity type:Organization
Organization Name:CENTRAL PARK MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SHAHNOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-974-0490
Mailing Address - Street 1:134 WEST, 58TH STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-974-0490
Mailing Address - Fax:212-974-0493
Practice Address - Street 1:134 WEST, 58TH STREET, SUITE102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-974-0490
Practice Address - Fax:212-974-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty