Healthcare Provider Details

I. General information

NPI: 1619688132
Provider Name (Legal Business Name): VISAVIS HEALTH CARE MEDICAL GROUP OF PENNSYLVANIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WEST AVE
WAYNE PA
19087-3322
US

IV. Provider business mailing address

250 SKILLMAN ST STE 202
BROOKLYN NY
11205-1218
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-6621
  • Fax:
Mailing address:
  • Phone: 212-734-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YITTY FALKOWITZ
Title or Position: OWNER
Credential:
Phone: 212-734-6621