Healthcare Provider Details

I. General information

NPI: 1386931798
Provider Name (Legal Business Name): VILLAGE DIAGNOSTIC AND TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121A WEST 20TH STREET
NEW YORK NY
10011
US

IV. Provider business mailing address

121A WEST 20TH STREET
NEW YORK NY
10011
US

V. Phone/Fax

Practice location:
  • Phone: 212-337-9290
  • Fax: 212-337-9275
Mailing address:
  • Phone: 212-337-9290
  • Fax: 212-337-9275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberF305430
License Number StateNY

VIII. Authorized Official

Name: NICHOLAS ROSSETTI
Title or Position: DIRECTOR
Credential: NP
Phone: 212-337-9273