Healthcare Provider Details

I. General information

NPI: 1053793513
Provider Name (Legal Business Name): WYCOFF HEIGHTS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20106 PARKER BEND LN
RICHMOND TX
77407-1669
US

IV. Provider business mailing address

20106 PARKER BEND LN
RICHMOND TX
77407-1669
US

V. Phone/Fax

Practice location:
  • Phone: 832-877-5749
  • Fax:
Mailing address:
  • Phone: 832-877-5749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberN004232
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE NGUYEN
Title or Position: DOCTOR PODIATRIC MEDICINE
Credential:
Phone: 832-877-5749