Basic Information
| Provider Information | |||||||||
| NPI: | 1780011676 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK CONSULTATION MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4526 41ST ST | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111043419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125626207 | ||||||||
| FaxNumber: | 7187661630 | ||||||||
| Practice Location | |||||||||
| Address1: | 3016 31ST ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111022269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125626207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2013 | ||||||||
| LastUpdateDate: | 10/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | BHUTIA | ||||||||
| AuthorizedOfficialFirstName: | NAMGYA; | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2125626207 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 258670 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 03370656 | 05 | NY | MEDICAID |