Healthcare Provider Details

I. General information

NPI: 1376630442
Provider Name (Legal Business Name): P. ANNE MCBRIDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 140
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST # 140
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5720
  • Fax: 212-746-4478
Mailing address:
  • Phone: 212-746-5720
  • Fax: 212-746-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number139529
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number139529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: