Healthcare Provider Details

I. General information

NPI: 1215008974
Provider Name (Legal Business Name): HEIGHTS MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 BROADWAY
NEW YORK NY
10033-3703
US

IV. Provider business mailing address

4120 BROADWAY
NEW YORK NY
10033-3703
US

V. Phone/Fax

Practice location:
  • Phone: 212-568-7403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number134922
License Number StateNY

VIII. Authorized Official

Name: LARRY M NEUMAN
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 212-568-7403