Healthcare Provider Details

I. General information

NPI: 1447291299
Provider Name (Legal Business Name): DOWNTOWN PRIMARY CARE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAIDEN LN RM 1902
NEW YORK NY
10038-4773
US

IV. Provider business mailing address

80 MAIDEN LN RM 1901
NEW YORK NY
10038-4717
US

V. Phone/Fax

Practice location:
  • Phone: 212-379-6480
  • Fax:
Mailing address:
  • Phone: 212-793-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REGINA WAGNER JANICIK
Title or Position: PARTNER
Credential: MD
Phone: 212-379-6480