Healthcare Provider Details

I. General information

NPI: 1912528811
Provider Name (Legal Business Name): TAYLOR JESSICA SEARS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 5TH AVE
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1176 5TH AVE
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9500
  • Fax:
Mailing address:
  • Phone: 212-241-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number330463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: