Healthcare Provider Details

I. General information

NPI: 1508022591
Provider Name (Legal Business Name): 425 MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST SUITE 4A
NEW YORK NY
10019-1104
US

IV. Provider business mailing address

425 W 59TH ST SUITE 4A
NEW YORK NY
10019-1104
US

V. Phone/Fax

Practice location:
  • Phone: 212-265-9866
  • Fax: 212-977-9111
Mailing address:
  • Phone: 212-265-9866
  • Fax: 212-977-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number153609
License Number StateNY

VIII. Authorized Official

Name: MR. MARCEL LAUFER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-265-9866