Healthcare Provider Details

I. General information

NPI: 1619166097
Provider Name (Legal Business Name): GPDDC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK AVE S 8TH FLOOR
NEW YORK NY
10003-1402
US

IV. Provider business mailing address

250 PARK AVE S FL 8
NEW YORK NY
10003-1402
US

V. Phone/Fax

Practice location:
  • Phone: 212-979-3237
  • Fax:
Mailing address:
  • Phone: 212-979-3237
  • Fax: 212-979-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954