Healthcare Provider Details

I. General information

NPI: 1477898633
Provider Name (Legal Business Name): PROFESSIONAL MEDICAL HEALTHCARE SERVICE OF NEW YORK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 MADISON AVE 6TH FLOOR
NEW YORK NY
10016-1101
US

IV. Provider business mailing address

275 MADISON AVE 6TH FLOOR
NEW YORK NY
10016-1101
US

V. Phone/Fax

Practice location:
  • Phone: 800-323-7963
  • Fax: 718-984-8424
Mailing address:
  • Phone: 800-323-7963
  • Fax: 718-984-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number254668-1
License Number StateNY

VIII. Authorized Official

Name: DR. JAMI AVELLINI
Title or Position: CEO
Credential: M.D.
Phone: 800-323-7963