Provider Demographics
NPI:1730524042
Name:NYMC PHELPS FAMILY MEDICINE RESIDENCY PROGRAM
Entity type:Organization
Organization Name:NYMC PHELPS FAMILY MEDICINE RESIDENCY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ZAKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-823-5534
Mailing Address - Street 1:701 N BROADWAY
Mailing Address - Street 2:NYMC PHELPS FAMILY MEDICINE RESIDENCY PROGRAM
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1020
Mailing Address - Country:US
Mailing Address - Phone:914-366-5359
Mailing Address - Fax:914-366-1578
Practice Address - Street 1:701 N BROADWAY
Practice Address - Street 2:NYMC PHELPS FAMILY MEDICINE RESIDENCY PROGRAM
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1020
Practice Address - Country:US
Practice Address - Phone:914-366-5359
Practice Address - Fax:914-366-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty