Healthcare Provider Details

I. General information

NPI: 1790140044
Provider Name (Legal Business Name): NYC DOWNTOWN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MADISON AVE 6TH FLOOR
NEW YORK NY
10017-6308
US

IV. Provider business mailing address

47 POCONO AVE
YONKERS NY
10701-5433
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-294-0420
Mailing address:
  • Phone: 914-376-6100
  • Fax: 914-294-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23018579
License Number StateNY

VIII. Authorized Official

Name: MELISSA NIELI
Title or Position: BILLER
Credential:
Phone: 914-376-6100