Healthcare Provider Details

I. General information

NPI: 1437382298
Provider Name (Legal Business Name): EMPIRE STATE MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MAIN ST
ROOSEVELT ISLAND NY
10044-0032
US

IV. Provider business mailing address

520 MAIN ST
ROOSEVELT ISLAND NY
10044-0032
US

V. Phone/Fax

Practice location:
  • Phone: 212-832-2310
  • Fax: 212-753-5507
Mailing address:
  • Phone: 212-832-2310
  • Fax: 212-753-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number123754
License Number StateNY

VIII. Authorized Official

Name: DR. JACK RESNICK
Title or Position: MD
Credential: MD
Phone: 212-832-2310