Healthcare Provider Details

I. General information

NPI: 1003972472
Provider Name (Legal Business Name): VICKI-JO DEUTSCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAST 17TH ST
NEW YORK NY
10003
US

IV. Provider business mailing address

1249 5TH AVE
NEW YORK NY
10029-4413
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2000
  • Fax:
Mailing address:
  • Phone: 212-360-3925
  • Fax: 212-289-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number159256
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: