Healthcare Provider Details

I. General information

NPI: 1457368052
Provider Name (Legal Business Name): JEFFREY I. MECHANICK, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 PARK AVE
NEW YORK NY
10128-1314
US

IV. Provider business mailing address

1192 PARK AVE
NEW YORK NY
10128-1314
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-2100
  • Fax: 212-831-2137
Mailing address:
  • Phone: 212-831-2100
  • Fax: 212-831-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number167522
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY I MECHANICK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 212-831-2100