MEDICAL ASSOCIATE OF WALL STREET, P.C. (NPI# 1912272592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912272592 |
| Entity Type | Organization |
| Organization Name | MEDICAL ASSOCIATE OF WALL STREET, P.C. |
| Practice Address |
65 Broadway Suite 903 New York NY 10006-2503 |
| Practice Telephone | 2122333040 |
| Practice Fax Number | 2123497529 |
| Mailing Telephone | 2122333040 |
| Mailing Fax Number | 2123497529 |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2017-01-18 |
| Authorized Official Name | DR. GLENN GANDELMAN (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2122333040 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
65 BROADWAY SUITE 903 |
| City | NEW YORK |
| State | NY |
| Zip Code | 10006-2503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437182375 | Jordan C. Stern | Otolaryngology | 65 Broadway, Suite 901, New York, NY 10006-2503 | 2006-07-07 |
| 1942849401 | Joseph Charles Cestaro | Physical Therapist | 65 Broadway, New York, NY 10006-2503 | 2020-01-02 |
| 1700443280 | Elizabeth Roper | Acupuncturist | 65 Broadway, New York, NY 10006-2503 | 2019-05-21 |
| 1578009270 | Ny Mobile Medical PC | Specialist | 65 Broadway, Ste 903, New York, NY 10006-2503 | 2017-01-18 |
| 1801270715 | Rosemary Ward | Nurse Practitioner | 65 Broadway, Suite 903, New York, NY 10006 | 2015-07-10 |
| 1588053557 | New York Speech & Voice Lab Pllc | Speech-Language Pathologist | 65 Broadway, Suite 822, New York, NY 10006-2503 | 2015-01-14 |
| 1154726479 | Wall Street Podiatry PC | Podiatrist | 65 Broadway, Unit 1103, New York, NY 10006-2503 | 2014-10-29 |
| 1487061065 | Erika Hellwig Mental Health Counselor Pllc | Counselor | 65 Broadway, 844, New York, NY 10006-2503 | 2014-07-16 |
| 1902220585 | Katie Lorenzo | Social Worker | 65 Broadway, 505, New York, NY 10006-2503 | 2014-02-18 |
| 1184068017 | Modern Dermatology Pllc | Specialist | 65 Broadway, New York, NY 10006-2503 | 2013-04-22 |
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| 1720563232 | Harveen Kaur | Physical Therapist | 65 Broadway, Ste. 603, New York, NY 10006 | 2018-10-01 |
| 1871032367 | Joanne Herskovits | Speech-Language Pathologist | 90 Trinity Place, Leadership and Public Service High School, New York, NY 10006 | 2017-02-16 |
| 1457801318 | Lifetime Physical Therapy | Clinic/Center | 2 Rector St # 1301, Lifetime Physical Therapy, New York, NY 10006 | 2016-10-04 |
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| 1801207022 | Jane Arkinstall | Social Worker | 39 Broadway Suite 200, Mjhs, New York, NY 10006 | 2014-05-09 |
| 1487077665 | Jacob Perlow Hospice | Medicare Defined Swing Bed Unit | 39 Broadway, Suite 200, Ny, NY 10006 | 2014-01-24 |
| 1003249301 | Calvin C. Krom IIi | Emergency Medicine | 39 Broadway Fl 3, New York, NY 10006 | 2013-08-10 |
| 1740535103 | Carol Lynn Say Tan | Physical Therapist | 61 Broadway Suite 2824, New York, NY 10006 | 2012-07-20 |
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| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1952834343 | Sheltering Arms Children and Family Services, Inc. | Clinic/Center | 305 7th Ave Fl 4, New York, NY 10001-6280 | 2017-04-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.