Healthcare Provider Details

I. General information

NPI: 1235443359
Provider Name (Legal Business Name): EAST HARLEM MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1767 PARK AVE 2ND FLOOR
NEW YORK NY
10035-1929
US

IV. Provider business mailing address

1767 PARK AVE 2ND FLOOR
NEW YORK NY
10035-1929
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-8900
  • Fax: 212-289-8981
Mailing address:
  • Phone: 212-289-8900
  • Fax: 212-289-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number234547
License Number StateNY

VIII. Authorized Official

Name: AHMED A ELSOURY
Title or Position: OWNER
Credential:
Phone: 212-289-8900