Provider Demographics
NPI:1487203378
Name:PRIVATE MEDICAL NEW YORK, PC
Entity type:Organization
Organization Name:PRIVATE MEDICAL NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:SHLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-473-7888
Mailing Address - Street 1:110 E 60TH ST # 808
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1688
Mailing Address - Country:US
Mailing Address - Phone:212-473-7888
Mailing Address - Fax:212-931-1888
Practice Address - Street 1:110 E 60TH ST # 808
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1688
Practice Address - Country:US
Practice Address - Phone:917-781-1919
Practice Address - Fax:917-722-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty