Healthcare Provider Details

I. General information

NPI: 1134942568
Provider Name (Legal Business Name): CAMNY MEDICAL SERVICES EAST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RIVER ST. 9TH FLOOR
HOBOKEN NJ
07030
US

IV. Provider business mailing address

221 RIVER ST. 9TH FLOOR
HOBOKEN NJ
07030
US

V. Phone/Fax

Practice location:
  • Phone: 888-383-5881
  • Fax:
Mailing address:
  • Phone: 888-383-5881
  • 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

VIII. Authorized Official

Name: DR. KRISTINE I MCCOY
Title or Position: OPERATIONS ADMINISTRATOR
Credential: MD
Phone: 888-383-5881