MEDICARE: IVY MEDICAL GROUP PLLC

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	207P00000X	Emergency Medicine Physician

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	:	1700558798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVY MEDICAL GROUP PLLC

Provider Business Mailing Address
First Line	:	885 3RD AVE FL 28
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4834
Country	:	US
Telephone Number	:	929-650-3990
Fax Number	:	929-996-6230

Provider Business Practice Location Address
First Line	:	885 3RD AVE FL 28
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4834
Country	:	US
Telephone Number	:	929-650-3990
Fax Number	:	929-996-6230

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	FAIGE MILLER
Credential	:
Telephone Number	:	718-534-0689

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	04/23/2026

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Directions to “IVY MEDICAL GROUP PLLC ” Practice Location

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