Provider Demographics
NPI:1548530702
Name:HARLEM RHEUMATOLOGY LLC
Entity type:Organization
Organization Name:HARLEM RHEUMATOLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAAENDORP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-360-5752
Mailing Address - Street 1:51 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3467
Mailing Address - Country:US
Mailing Address - Phone:212-360-5752
Mailing Address - Fax:
Practice Address - Street 1:301 W 118TH ST
Practice Address - Street 2:APT PH-3F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1049
Practice Address - Country:US
Practice Address - Phone:212-360-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01921948Medicaid
NYG70929Medicare UPIN
NY80V631Medicare PIN