Healthcare Provider Details

I. General information

NPI: 1326413691
Provider Name (Legal Business Name): MEGAN E. VILCEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COLUMBUS CIR 8TH FLOOR
NEW YORK NY
10019
US

IV. Provider business mailing address

5 COLUMBUS CIR 8TH FLOOR
NEW YORK NY
10019-1412
US

V. Phone/Fax

Practice location:
  • Phone: 212-664-9323
  • Fax:
Mailing address:
  • Phone: 212-664-9323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001006048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: