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General NPI Number Information
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NPI Number | 1669817938
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Entity Type | Organization
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Legal Business Name | CORRECTIONAL MEDICAL ASSOCIATES OF NEWYORK, P.C.
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 4904 19TH AVE
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City | ASTORIA
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State | NY
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Zip | 11105-1002
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Country | US
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Telephone | 347-774-7015
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Fax | 347-774-8051
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Provider Business Mailing Address
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Address Line | 4904 19TH AVE
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City | ASTORIA
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State | NY
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Zip | 11105-1002
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Country | US
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Telephone | 347-774-7015
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Fax | 347-774-8051
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAY COWAN
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Credential | M.D.
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Telephone | 347-774-7015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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