Healthcare Provider Details

I. General information

NPI: 1851049134
Provider Name (Legal Business Name): CINQ-NY-IPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BROAD ST
NEW YORK NY
10004-2304
US

IV. Provider business mailing address

30 BROAD ST
NEW YORK NY
10004-2304
US

V. Phone/Fax

Practice location:
  • Phone: 716-247-5282
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEVE SWIFT
Title or Position: BILLING PROJECT MANAGER
Credential: CFO
Phone: 716-247-5282