Healthcare Provider Details

I. General information

NPI: 1487801437
Provider Name (Legal Business Name): LUCILLE R. VAN HOOK SPIVACK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MORRIS PARK AVE
BRONX NY
10461-1400
US

IV. Provider business mailing address

PO BOX 749
BRONX NY
10469-0701
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-4227
  • Fax:
Mailing address:
  • Phone: 718-828-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number141418
License Number StateNY

VIII. Authorized Official

Name: LUCILLE R VAN HOOK
Title or Position: SOLE PROPRIETER
Credential:
Phone: 718-828-4227