Healthcare Provider Details

I. General information

NPI: 1225736705
Provider Name (Legal Business Name): 180 DEGREES MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 MALCOLM X BLVD APT 11D
NEW YORK NY
10037-1206
US

IV. Provider business mailing address

620 MALCOLM X BLVD APT 11D
NEW YORK NY
10037-1206
US

V. Phone/Fax

Practice location:
  • Phone: 251-599-2388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TREMAINE JAMAR WRIGHT
Title or Position: OWNER
Credential: DO
Phone: 251-599-2388