Provider Demographics
NPI:1053173872
Name:NEW YORK STATE MEDICAL HEALTH SERVICES PC
Entity type:Organization
Organization Name:NEW YORK STATE MEDICAL HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-331-7908
Mailing Address - Street 1:PO BOX 809235
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9201
Mailing Address - Country:US
Mailing Address - Phone:248-607-0037
Mailing Address - Fax:734-462-0344
Practice Address - Street 1:400 RELLA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-4241
Practice Address - Country:US
Practice Address - Phone:888-402-0202
Practice Address - Fax:888-860-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty