Healthcare Provider Details

I. General information

NPI: 1609304179
Provider Name (Legal Business Name): NYC 23RD STREET MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W 20TH ST
NEW YORK NY
10011-3639
US

IV. Provider business mailing address

1053 SAW MILL RIVER RD # SUITELL1
ARDSLEY NY
10502-1048
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax:
Mailing address:
  • Phone: 914-376-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA NIELI
Title or Position: BILLING MANAGER
Credential:
Phone: 914-376-6100