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General NPI Number Information
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NPI Number | 1265621494
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Entity Type | Organization
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Legal Business Name | DOUGLAS E MENIKHEIM MD JEFFREY S KALMAN MD & C YIACHOS MD PC
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 129 SLOSSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-2522
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Country | US
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Telephone | 718-720-5928
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Fax | 718-720-6706
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Provider Business Mailing Address
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Address Line | 129 SLOSSON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-2522
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Country | US
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Telephone | 718-720-5928
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Fax | 718-720-6706
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. ANN MCCORMICK
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Credential |
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Telephone | 718-720-5928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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