Organization
FIFTH AVENUE MEDICAL ASSOCIATES, LLC
Active
Other names
Beny J. Primm Medical Group, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES Y JIN M.D. (MEMBER)
(646) 898-2037
Entity
Organization
Contact information
Practice address
745 5TH AVE, SUITE 500, NEW YORK, NY 10151-0099
(646) 898-2037
Mailing address
745 5TH AVE, SUITE 500, NEW YORK, NY 10151-0099
(646) 898-2037
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
101838
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02216131
—
NY
Enumeration date
05/03/2016
Last updated
11/19/2018
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