Healthcare Provider Details

I. General information

NPI: 1184058992
Provider Name (Legal Business Name): HCA IN MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST STE 504
NEW YORK NY
10022-1236
US

IV. Provider business mailing address

2535 ARTHUR KILL RD
STATEN ISLAND NY
10309-1207
US

V. Phone/Fax

Practice location:
  • Phone: 212-886-1097
  • Fax: 718-967-6023
Mailing address:
  • Phone: 718-448-3210
  • Fax: 718-984-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL I BERKLEY
Title or Position: CEO & ADMINISTRATOR
Credential:
Phone: 718-448-3210