Healthcare Provider Details

I. General information

NPI: 1487698726
Provider Name (Legal Business Name): JAMES M CHURCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE FL 8
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

6000 W CREEK RD SUITE 10
INDEPENDENCE OH
44131-2139
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-1155
  • Fax:
Mailing address:
  • Phone: 800-223-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number312219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: