Healthcare Provider Details

I. General information

NPI: 1801891072
Provider Name (Legal Business Name): ENESLOW PEDORTHIC ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 BROADWAY
NEW YORK NY
10010-6007
US

IV. Provider business mailing address

924 BROADWAY
NEW YORK NY
10010-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-2300
  • Fax: 212-477-2156
Mailing address:
  • Phone: 212-477-2300
  • Fax: 212-477-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SCHWARTZ
Title or Position: PRESIDENT
Credential: C.PED.
Phone: 212-477-2300