MEDICARE: VILLAGE DIAGNOSTIC AND TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	70021B1R	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457424863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE DIAGNOSTIC AND TREATMENT CENTER

Provider Business Mailing Address
First Line	:	154 CHRISTOPHER ST
Second Line	:	SUITE 2D
City	:	NEW YORK
State	:	NY
Zip	:	10014-2840
Country	:	US
Telephone Number	:	212-337-5816
Fax Number	:	212-337-5839

Provider Business Practice Location Address
First Line	:	121A W 20TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-3601
Country	:	US
Telephone Number	:	212-337-9293
Fax Number	:	212-337-9275

Authorized Official
Title or Position	:	C.E.O.
Name	:	MRS. EMMA DEVITO
Credential	:
Telephone Number	:	121-337-5600

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	06/13/2013

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Directions to “VILLAGE DIAGNOSTIC AND TREATMENT CENTER ” Practice Location

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