Healthcare Provider Details

I. General information

NPI: 1588234025
Provider Name (Legal Business Name): IVEE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHARLES EWING BLVD STE 160
EWING NJ
08628-3456
US

IV. Provider business mailing address

81 PROSPECT ST
BROOKLYN NY
11201-1473
US

V. Phone/Fax

Practice location:
  • Phone: 212-878-7685
  • Fax:
Mailing address:
  • Phone: 212-878-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KYON A HOOD
Title or Position: CMO
Credential: MD
Phone: 212-878-7685