Healthcare Provider Details

I. General information

NPI: 1740879055
Provider Name (Legal Business Name): NY ENDOVASCULAR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 116TH ST STE 300
NEW YORK NY
10029-1704
US

IV. Provider business mailing address

182 INDUSTRIAL RD
GLEN ROCK PA
17327-8626
US

V. Phone/Fax

Practice location:
  • Phone: 646-791-2274
  • Fax: 646-791-2435
Mailing address:
  • Phone: 833-426-3636
  • Fax: 717-759-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL SCHUR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 717-759-5148