Healthcare Provider Details

I. General information

NPI: 1124417076
Provider Name (Legal Business Name): PATRICK JAMES HURLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 11/04/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 FORT WASHINGTON AVE # M9GN
NEW YORK NY
10032-3733
US

IV. Provider business mailing address

177 FORT WASHINGTON AVE UNIT 9GN
NEW YORK NY
10032-3733
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3090
  • Fax:
Mailing address:
  • Phone: 212-305-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number290079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: