Healthcare Provider Details

I. General information

NPI: 1639581846
Provider Name (Legal Business Name): TAYLOR BRYAN SEWELL MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 09/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY
NEW YORK NY
10032
US

IV. Provider business mailing address

622 W 168TH ST, VC4-417
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number288683
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: