Healthcare Provider Details

I. General information

NPI: 1699279885
Provider Name (Legal Business Name): STAT UROLOGY MEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 5TH AVE
NEW YORK NY
10021-2661
US

IV. Provider business mailing address

4 E 76TH ST
NEW YORK NY
10021-2676
US

V. Phone/Fax

Practice location:
  • Phone: 718-483-7372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: YANIV LARISH
Title or Position: MD
Credential:
Phone: 212-370-4170