Organization
NY EMPIRE MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCHELL L KAPHAN M.D. (MEDICAL DIRECTOR)
(718) 418-0300
Entity
Organization
Contact information
Practice address
5629 METROPOLITAN AVE, RIDGEWOOD, NY 11385-1975
(718) 418-0300
(718) 418-0301
Mailing address
5629 METROPOLITAN AVE, RIDGEWOOD, NY 11385-1975
(718) 418-0300
(718) 418-0301
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
TUV006843
NY
174400000X
Specialist
139985
NY
207R00000X
Internal Medicine Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139985
LICENSE
NY
Enumeration date
12/06/2007
Last updated
05/04/2015
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