Healthcare Provider Details

I. General information

NPI: 1982625950
Provider Name (Legal Business Name): BISHER AKIL MD A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W 19TH ST FL 4
NEW YORK NY
10011-4121
US

IV. Provider business mailing address

155 W 19TH ST FL 4
NEW YORK NY
10011-4121
US

V. Phone/Fax

Practice location:
  • Phone: 212-929-2629
  • Fax:
Mailing address:
  • Phone: 212-929-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number2363971
License Number StateNY

VIII. Authorized Official

Name: MR. BISHER AKIL
Title or Position: PHYSICIAN OWNER PRES
Credential: MD
Phone: 212-929-2629