Provider Demographics
NPI:1962883900
Name:MEDISPA ONE NY PLAZA LLC
Entity type:Organization
Organization Name:MEDISPA ONE NY PLAZA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANSARICQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-907-1546
Mailing Address - Street 1:1 NEW YORK PLZ
Mailing Address - Street 2:CONCOURSE LEVEL, WHITEHALL STREET
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1901
Mailing Address - Country:US
Mailing Address - Phone:646-918-6883
Mailing Address - Fax:646-737-6883
Practice Address - Street 1:1 NEW YORK PLZ
Practice Address - Street 2:CONCOURSE LEVEL, WHITEHALL STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1901
Practice Address - Country:US
Practice Address - Phone:646-918-6883
Practice Address - Fax:646-737-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy