Healthcare Provider Details

I. General information

NPI: 1700847803
Provider Name (Legal Business Name): DOUGLAS UNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 57TH ST SUITE 1208
NEW YORK NY
10019-3211
US

IV. Provider business mailing address

PO BOX 33391
HARTFORD CT
06150-3391
US

V. Phone/Fax

Practice location:
  • Phone: 212-636-3800
  • Fax: 212-523-7575
Mailing address:
  • Phone: 212-308-1112
  • Fax: 212-308-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number232089
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number232089
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: