Healthcare Provider Details

I. General information

NPI: 1831796408
Provider Name (Legal Business Name): UNITED HARLEM SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 125TH ST
NEW YORK NY
10035-1612
US

IV. Provider business mailing address

9 VERNON PL APT 1
MOUNT VERNON NY
10552-2325
US

V. Phone/Fax

Practice location:
  • Phone: 646-657-8151
  • Fax: 607-289-3126
Mailing address:
  • Phone: 646-657-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEREK MERCER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 646-657-8151