Healthcare Provider Details

I. General information

NPI: 1417586595
Provider Name (Legal Business Name): VASCULAR MEDICINE OF NEW YORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WESTCHESTER AVE STE 201
BRONX NY
10461-4580
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 900
GREENBELT MD
20770-3504
US

V. Phone/Fax

Practice location:
  • Phone: 301-486-4690
  • Fax:
Mailing address:
  • Phone: 301-982-2000
  • Fax: 301-982-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD KENNEDY
Title or Position: CHIEF EXECUTIVE OFFICE
Credential: PA-C
Phone: 301-982-2000