Provider Demographics
NPI:1730259581
Name:ST. VINCENT'S 52ND ST. MEDICAL PRACTICE, PC
Entity type:Organization
Organization Name:ST. VINCENT'S 52ND ST. MEDICAL PRACTICE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:696-778-5545
Mailing Address - Street 1:355 W 52ND ST
Mailing Address - Street 2:7TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6239
Mailing Address - Country:US
Mailing Address - Phone:646-778-5546
Mailing Address - Fax:
Practice Address - Street 1:355 W 52ND ST
Practice Address - Street 2:7TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6239
Practice Address - Country:US
Practice Address - Phone:646-778-5546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000332Medicare PIN