Fifth Avenue Medical Associates, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

101838 Issued in NY

Legal business name

FIFTH AVENUE MEDICAL ASSOCIATES, LLC

Practice address

745 5TH Ave
Suite 500
New York, NY 10151-0099

Phone

(646) 898-2037

NPI assigned

May 3, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Y Jin, M.D.

Title

Member

Phone

(646) 898-2037

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Beny J. Primm Medical Group, LLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1083069439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 5TH AVE",
            "address_2": "SUITE 500",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101510099",
            "telephone_number": "646-898-2037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 5TH AVE",
            "address_2": "SUITE 500",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101510099",
            "telephone_number": "646-898-2037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIFTH AVENUE MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "JIN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "646-898-2037",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NY",
            "license": "101838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02216131",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beny J. Primm Medical Group, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Fifth Ave Podiatric Surgery Suite
• Fifth Avenue Acup Health Inc
• Fifth Avenue Anesthesia Associates, PC
• Fifth Avenue Center
• Fifth Avenue Center for Counseling and Psychotherapy, Inc.
• Fifth Avenue Medical Healthcare PC
• Fifth Avenue Medical Operatory
• Fifth Avenue Medical Services, P.C.
• Fifth Avenue Millennium Aesthetic Surgery PLLC
• Fifth Avenue Neurology, PLLC

• Health Service Clinic/Center in New York, NY
• Providers in New York, NY by specialty
• Health Service Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.