Healthcare Provider Details

I. General information

NPI: 1851531776
Provider Name (Legal Business Name): SVCMC PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 12TH ST SUITE 5
NEW YORK NY
10011-8202
US

IV. Provider business mailing address

450 W 33RD ST PBS 12TH FL
NEW YORK NY
10001-2603
US

V. Phone/Fax

Practice location:
  • Phone: 212-356-4400
  • Fax: 212-356-4450
Mailing address:
  • Phone: 212-356-4400
  • Fax: 212-356-4450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MARIANI
Title or Position: SENIOR VP OF FINANCE
Credential:
Phone: 212-356-4405