Healthcare Provider Details

I. General information

NPI: 1053611269
Provider Name (Legal Business Name): JUDITH MORRIS DE CELIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 09/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 E 30TH ST
NEW YORK NY
10016-8318
US

IV. Provider business mailing address

330 E 38TH ST APT 31J
NEW YORK NY
10016-2781
US

V. Phone/Fax

Practice location:
  • Phone: 212-679-2213
  • Fax: 917-388-2678
Mailing address:
  • Phone: 917-940-7258
  • Fax: 917-388-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number134562
License Number StateNY

VIII. Authorized Official

Name: DR. JUDITH MORRIS DE CELIS
Title or Position: PRESIDENT
Credential: MD
Phone: 212-679-2213