Healthcare Provider Details

I. General information

NPI: 1902052392
Provider Name (Legal Business Name): SLRHC FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE SUIT 11G
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

1000 10TH AVE SUIT 11G
NEW YORK NY
10019-1147
US

V. Phone/Fax

Practice location:
  • Phone: 212-636-3400
  • Fax:
Mailing address:
  • Phone: 212-636-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH HACKETT
Title or Position: AVP
Credential:
Phone: 212-256-3424