Provider Demographics
NPI:1053359505
Name:EAST MERRICK MEDICAL, PC
Entity type:Organization
Organization Name:EAST MERRICK MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:516-872-2200
Mailing Address - Street 1:10 E MERRICK RD
Mailing Address - Street 2:STE 306
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5800
Mailing Address - Country:US
Mailing Address - Phone:516-872-2200
Mailing Address - Fax:
Practice Address - Street 1:10 E MERRICK RD
Practice Address - Street 2:STE 306
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5800
Practice Address - Country:US
Practice Address - Phone:516-872-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTIN
NY=========OtherTIN