Healthcare Provider Details

I. General information

NPI: 1114467842
Provider Name (Legal Business Name): LICEFIX, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 E 81ST ST
NEW YORK NY
10028-3209
US

IV. Provider business mailing address

939 8TH AVE SUITE 302
NEW YORK NY
10019-4264
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-5200
  • Fax:
Mailing address:
  • Phone: 212-759-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: ADELE HOROWITZ
Title or Position: PRESIDENT
Credential:
Phone: 212-759-5200