Provider Demographics
NPI:1972723427
Name:EMERSON MEDICAL PLLC
Entity type:Organization
Organization Name:EMERSON MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-448-3800
Mailing Address - Street 1:11 RALPH PLACE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-448-3800
Mailing Address - Fax:718-448-2003
Practice Address - Street 1:11 RALPH PLACE
Practice Address - Street 2:SUITE 305
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304
Practice Address - Country:US
Practice Address - Phone:718-448-3800
Practice Address - Fax:718-448-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229483207R00000X
NJ25MA07633200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P2995181OtherOXFORD
NY02530716Medicaid
P2995181OtherOXFORD
I03208Medicare UPIN