Healthcare Provider Details

I. General information

NPI: 1659304541
Provider Name (Legal Business Name): JANICE L. FALLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 EASTCHESTER RD ROOM 722
BRONX NY
10461-2301
US

IV. Provider business mailing address

1825 EASTCHESTER RD ROOM 722
BRONX NY
10461-2301
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-2476
  • Fax: 718-904-2774
Mailing address:
  • Phone: 718-904-2476
  • Fax: 718-904-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number240667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: