Healthcare Provider Details

I. General information

NPI: 1336585314
Provider Name (Legal Business Name): TAKE CARE MEDICAL HEALTH NEW YORK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 BROADWAY
NEW YORK NY
10019-7407
US

IV. Provider business mailing address

1901 E VOORHEES ST MS 640
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 855-925-4733
  • Fax: 217-709-2345
Mailing address:
  • Phone: 855-925-4733
  • Fax: 217-709-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PHIPPS
Title or Position: CHIEF FINANCIAL OFFICIAL/AGENT
Credential:
Phone: 855-925-4733