Basic Information
| Provider Information | |||||||||
| NPI: | 1831509751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARISS MEDICAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | BAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117090357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167944161 | ||||||||
| FaxNumber: | 5167949568 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 MADISON AVE | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100225403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127526770 | ||||||||
| FaxNumber: | 2127540369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | SEIDENBERG | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6462634120 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1992981 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 2I0311 | 01 | NY | MEDICARE PTAN | OTHER |