MODERN MEDICAL PC NPI 1417057951

NPI Information

NPI: 1417057951
Provider Name: MODERN MEDICAL PC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 33D1092135

Address:
225 BROADWAY STE 1420
NEW YORK, NY
ZIP 10007
Phone: (212) 571-5000
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MODERN MEDICAL PC is a primary care clinic center in New York, NY. MODERN MEDICAL PC NPI is 1417057951. The provider is registered as an organization entity type.

The provider's business location address is:

225 BROADWAY STE 1420
NEW YORK, NY
ZIP 10007-771
Phone: (212) 571-5000
Fax: (212) 571-5001

The provider's authorized official is Ilya Kleyn .
The authorized official title is Md and has the following contact phone number (212) 571-5000.

The CLIA number assigned to this NPI record is 33D1092135 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/24/2006 and was last updated on 4/8/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	215006	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	02091596	MEDICAID	NEW YORK
2	H18461	MEDICARE UPIN	NEW YORK
3	223AK1	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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