Healthcare Provider Details

I. General information

NPI: 1801412523
Provider Name (Legal Business Name): FIFTH AVE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E 68TH ST
NEW YORK NY
10065-4901
US

IV. Provider business mailing address

3 E 68TH ST
NEW YORK NY
10065-4901
US

V. Phone/Fax

Practice location:
  • Phone: 212-988-1444
  • Fax: 212-988-1755
Mailing address:
  • Phone: 212-988-1444
  • Fax: 212-988-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIF SECKIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-915-0408