Healthcare Provider Details

I. General information

NPI: 1194350066
Provider Name (Legal Business Name): VISAVIS HEALTH CARE MEDICAL GROUP OF NY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 MCDONALD AVE
BROOKLYN NY
11230-4667
US

IV. Provider business mailing address

3923 FORT HAMILTON PARKWAY
BROOKLYN NY
11218-1916
US

V. Phone/Fax

Practice location:
  • Phone: 929-491-7333
  • Fax:
Mailing address:
  • Phone: 212-734-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YITTY FALKOWITZ
Title or Position: MANAGER
Credential:
Phone: 212-734-6621