Healthcare Provider Details

I. General information

NPI: 1336578772
Provider Name (Legal Business Name): ADVANTAGECARE PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 95TH ST
NEW YORK NY
10128-4077
US

IV. Provider business mailing address

55 WATER STREET 12TH FLOOR
NEW YORK NY
10041
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-8000
  • Fax: 212-423-3904
Mailing address:
  • Phone: 646-680-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NAVARRA RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 646-680-1551