Healthcare Provider Details

I. General information

NPI: 1205200417
Provider Name (Legal Business Name): NYC MIDTOWN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164A LOCKWOOD AVE
YONKERS NY
10701-5412
US

IV. Provider business mailing address

164A LOCKWOOD AVE
YONKERS NY
10701-5412
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax: 914-470-5056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number305343
License Number StateNY

VIII. Authorized Official

Name: JANE ALEXANDER
Title or Position: ANP
Credential: ANP
Phone: 914-376-6100