MEDICARE: NES MEDICAL SERVICES OF NEW YORK PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CL0022	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	W21801	OTHER	NY	GROUP BCBS #

General Provider Information

NPI Number	:	1417939687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NES MEDICAL SERVICES OF NEW YORK PC

Provider Business Mailing Address
First Line	:	PO BOX 409041
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-9041
Country	:	US
Telephone Number	:	800-377-8721
Fax Number	:	304-697-1155

Provider Business Practice Location Address
First Line	:	150 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2559
Country	:	US
Telephone Number	:	718-630-7185
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN AND CEO
Name	:	ALLAN H. RAPPAPORT
Credential	:
Telephone Number	:	415-435-4591

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	05/21/2013

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