Healthcare Provider Details

I. General information

NPI: 1215280847
Provider Name (Legal Business Name): INNOVATIVE HEALTH CARE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E TREMONT AVE B
BRONX NY
10460-4301
US

IV. Provider business mailing address

913 E TREMONT AVE B
BRONX NY
10460-4301
US

V. Phone/Fax

Practice location:
  • Phone: 718-860-0200
  • Fax:
Mailing address:
  • Phone:
  • 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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JO-ANN SHAKARJIAN
Title or Position: M.D
Credential:
Phone: 718-860-0200