Provider Demographics
NPI:1902989312
Name:NEW YORK FAMILY MEDICINE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:NEW YORK FAMILY MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-896-0229
Mailing Address - Street 1:PO BOX 2041
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-0441
Mailing Address - Country:US
Mailing Address - Phone:718-960-6608
Mailing Address - Fax:718-960-3635
Practice Address - Street 1:470 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5108
Practice Address - Country:US
Practice Address - Phone:718-960-3805
Practice Address - Fax:718-960-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01922641Medicaid
NYW33331Medicare ID - Type Unspecified
NY01922641Medicaid