Healthcare Provider Details

I. General information

NPI: 1790980605
Provider Name (Legal Business Name): MICHELLE LA MOTHE M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST 56TH STREET
NEW YORK NY
10022-4144
US

IV. Provider business mailing address

300 EAST 56TH STREET
NEW YORK NY
10022-4144
US

V. Phone/Fax

Practice location:
  • Phone: 212-722-6224
  • Fax: 212-876-4568
Mailing address:
  • Phone: 212-722-6224
  • Fax: 212-876-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number209798
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: