Healthcare Provider Details

I. General information

NPI: 1407187917
Provider Name (Legal Business Name): MEDCOR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROCKEFELLER PLZ SUITE 754S-9
NEW YORK NY
10112-0015
US

IV. Provider business mailing address

30 ROCKEFELLER PLZ SUITE 754S -9
NEW YORK NY
10112-0015
US

V. Phone/Fax

Practice location:
  • Phone: 212-664-4444
  • Fax:
Mailing address:
  • Phone: 212-664-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberF33677-1
License Number StateNY

VIII. Authorized Official

Name: MS. SALLY ANNE JUSTINE REXACH
Title or Position: NURSE PRACTITIONER
Credential: APRN, MSN, FNP-C
Phone: 212-664-4444