Basic Information
| Provider Information | |||||||||
| NPI: | 1407512130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONE MEDICAL OF NY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 EMBARCADERO CTR STE 1900 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941113723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156586791 | ||||||||
| FaxNumber: | 4155200904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1585 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100368200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122965777 | ||||||||
| FaxNumber: | 2127614758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2021 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | DIAMOND | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4156586791 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ONE MEDICAL OF NY, P.C. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.