NPIMap

Organization Active NPI

East Village Integrated Medical, PC

  • Sports Medicine (Family Medicine) Physician
  • New York, NY
National Provider Identifier
1326572181
Registry record updated Nov 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
264414 Issued in NY
Legal business name
EAST VILLAGE INTEGRATED MEDICAL, PC
Practice address
33 E 7TH St
New York, NY 10003-8191
Phone
(212) 260-2213
Fax
(212) 260-2354
NPI assigned
Apr 18, 2017
Last updated
Nov 13, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2017

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

Authorized official

Name
Taras Odulak, DCNPI 1750474011
Title
Ceo
Phone
(212) 260-2213

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X X006018 NY
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X 264414 NY Primary
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X 264414 NY
Sports Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251S0007X

Addresses

Primary practice location

33 E 7TH St
New York, NY 10003-8191

Mailing address

33 E 7TH St
New York, NY 10003-8191
Phone (212) 260-2213

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510531200000",
    "number": "1326572181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 E 7TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100038191",
            "telephone_number": "212-260-2213",
            "fax_number": "212-260-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 E 7TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100038191",
            "telephone_number": "212-260-2213",
            "fax_number": "212-260-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VILLAGE INTEGRATED MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-18",
        "last_updated": "2017-11-13",
        "status": "A",
        "authorized_official_last_name": "ODULAK",
        "authorized_official_first_name": "TARAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "212-260-2213",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X006018",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NY",
            "license": "264414",
            "primary": true
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "NY",
            "license": "264414",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2017; 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.