Healthcare Provider Details

I. General information

NPI: 1891999686
Provider Name (Legal Business Name): DR. KAMEELAH ANJAIL PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E 78TH ST
NEW YORK NY
10075-0406
US

IV. Provider business mailing address

162 E 78TH ST
NEW YORK NY
10075-0406
US

V. Phone/Fax

Practice location:
  • Phone: 332-217-0335
  • Fax: 332-217-0303
Mailing address:
  • Phone: 332-217-0335
  • Fax: 332-217-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number253401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: