Healthcare Provider Details

I. General information

NPI: 1952580367
Provider Name (Legal Business Name): CHELSEA VILLAGE MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 04/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 5TH AVENUE, 3RD FLOOR SUITE 350
NEW YORK NY
10016
US

IV. Provider business mailing address

245 5TH AVENUE, 3RD FLOOR SUITE 350
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 212-929-2629
  • Fax: 212-929-4971
Mailing address:
  • Phone: 212-929-2629
  • Fax: 212-929-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBA9377979
License Number StateNY

VIII. Authorized Official

Name: BISHER AKIL
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 212-929-2629