Healthcare Provider Details

I. General information

NPI: 1396842522
Provider Name (Legal Business Name): NEW YORK SPECIALTY PHYSICIANS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PLANDOME RD
MANHASSET NY
11030-2331
US

IV. Provider business mailing address

25 GILCHREST RD
GREAT NECK NY
11021-1404
US

V. Phone/Fax

Practice location:
  • Phone: 516-570-0528
  • Fax:
Mailing address:
  • Phone: 516-570-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number205912
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number206320
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5N5751
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE NUMBER
# 2
Identifier01711802
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier01711811
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MONIKA ISABELA WORONIECKA
Title or Position: PARTNER
Credential: M.D.
Phone: 516-570-0528