MEDICARE: NY EMPIRE MEDICAL 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	174400000X	Specialist	139985	NY
2	207R00000X	Internal Medicine Physician
3	261QP2000X	Physical Therapy Clinic/Center
4	261QX0100X	Occupational Medicine Clinic/Center
5	152W00000X	Optometrist	TUV006843	NY
6	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	139985	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1902089568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY EMPIRE MEDICAL PC

Provider Business Mailing Address
First Line	:	5629 METROPOLITAN AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-1975
Country	:	US
Telephone Number	:	718-418-0300
Fax Number	:	718-418-0301

Provider Business Practice Location Address
First Line	:	5629 METROPOLITAN AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-1975
Country	:	US
Telephone Number	:	718-418-0300
Fax Number	:	718-418-0301

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MITCHELL L KAPHAN
Credential	:	M.D.
Telephone Number	:	718-418-0300

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	05/04/2015

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Directions to “NY EMPIRE MEDICAL PC ” Practice Location

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