Healthcare Provider Details

I. General information

NPI: 1639382245
Provider Name (Legal Business Name): PATRICK OLIVER EMANUEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

333 E 93RD ST #5C
NEW YORK NY
10128-5503
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6064
  • Fax:
Mailing address:
  • Phone: 646-519-1537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number002817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: