Healthcare Provider Details

I. General information

NPI: 1275064826
Provider Name (Legal Business Name): MAINLINE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10814 72ND AVE 4TH FLR
FOREST HILLS NY
11375-7081
US

IV. Provider business mailing address

10814 72ND AVE 4TH FLR
FOREST HILLS NY
11375-7081
US

V. Phone/Fax

Practice location:
  • Phone: 718-520-8480
  • Fax:
Mailing address:
  • Phone: 718-520-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY SILVER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-520-8480