Healthcare Provider Details

I. General information

NPI: 1639137813
Provider Name (Legal Business Name): FIFTH AVENUE MEDICAL HEALTHCARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 5TH AVE
NEW YORK NY
10128-0724
US

IV. Provider business mailing address

1150 5TH AVE
NEW YORK NY
10128-0724
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-2828
  • Fax: 212-860-9134
Mailing address:
  • Phone: 212-289-2828
  • Fax: 212-860-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number103832
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number092748
License Number StateNY

VIII. Authorized Official

Name: DR. EDWARD P AMBINDER
Title or Position: PRESIDENT
Credential: MD
Phone: 212-289-2828