Provider Demographics
NPI:1205563319
Name:NY FAMILY MEDICINE PC
Entity type:Organization
Organization Name:NY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DOYOUNG
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:347-506-0325
Mailing Address - Street 1:14809 NORTHERN BLVD STE 1K
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4308
Mailing Address - Country:US
Mailing Address - Phone:347-506-0325
Mailing Address - Fax:347-506-0314
Practice Address - Street 1:14809 NORTHERN BLVD STE 1K
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4308
Practice Address - Country:US
Practice Address - Phone:347-506-0325
Practice Address - Fax:347-506-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty