Healthcare Provider Details

I. General information

NPI: 1508149642
Provider Name (Legal Business Name): NOHO MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 BROADWAY STE 303
NEW YORK NY
10012-2614
US

IV. Provider business mailing address

10 DOWNING ST STE. 1U
NEW YORK NY
10014-4734
US

V. Phone/Fax

Practice location:
  • Phone: 212-645-1495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ARNOLD J BLANK
Title or Position: DIRECTOR
Credential: M.D.
Phone: 212-645-0081