Healthcare Provider Details

I. General information

NPI: 1902207061
Provider Name (Legal Business Name): HARLEM EAST LIFE PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 2ND AVE
NEW YORK NY
10035-3108
US

IV. Provider business mailing address

2367 2ND AVE
NEW YORK NY
10035-3108
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-2300
  • Fax: 917-492-9292
Mailing address:
  • Phone: 212-876-2300
  • Fax: 917-492-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNE N KING
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 212-876-2300