Healthcare Provider Details

I. General information

NPI: 1902089568
Provider Name (Legal Business Name): NY EMPIRE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 METROPOLITAN AVE
RIDGEWOOD NY
11385-1975
US

IV. Provider business mailing address

5629 METROPOLITAN AVE
RIDGEWOOD NY
11385-1975
US

V. Phone/Fax

Practice location:
  • Phone: 718-418-0300
  • Fax: 718-418-0301
Mailing address:
  • Phone: 718-418-0300
  • Fax: 718-418-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006843
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number139985
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL L KAPHAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-418-0300