Healthcare Provider Details

I. General information

NPI: 1841475886
Provider Name (Legal Business Name): 853 MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 5TH AVE
NEW YORK NY
10065-5802
US

IV. Provider business mailing address

853 5TH AVE
NEW YORK NY
10065-5802
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-3187
  • Fax: 212-772-3442
Mailing address:
  • Phone: 212-772-3187
  • Fax: 212-772-3442

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: DR. MAURO C ROMITA
Title or Position: OWNER
Credential: M.D.
Phone: 212-772-3187