Healthcare Provider Details

I. General information

NPI: 1427368281
Provider Name (Legal Business Name): DDM MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E 42ND ST SUITE 2901
NEW YORK NY
10168-0002
US

IV. Provider business mailing address

1357 BROADWAY # 245
NEW YORK NY
10018-7101
US

V. Phone/Fax

Practice location:
  • Phone: 917-701-6570
  • Fax:
Mailing address:
  • Phone: 212-757-8686
  • Fax: 917-475-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number245042
License Number StateNY

VIII. Authorized Official

Name: HOWARD SCHWARTZ
Title or Position: OFFICER
Credential: MD
Phone: 917-701-6570