Healthcare Provider Details

I. General information

NPI: 1831489582
Provider Name (Legal Business Name): COLUMBUS CIRCLE MEDICAL SERVICES,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 W 54TH ST 8TH FLOOR
NEW YORK NY
10019-3545
US

IV. Provider business mailing address

619 W 54TH ST 8TH FLOOR
NEW YORK NY
10019-3545
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-3384
  • Fax: 212-874-0031
Mailing address:
  • Phone: 212-874-3384
  • Fax: 212-874-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number195225-1
License Number StateNY

VIII. Authorized Official

Name: LESLIE SEECOOMAR
Title or Position: MBR
Credential: MD
Phone: 212-874-8834