Healthcare Provider Details

I. General information

NPI: 1649058215
Provider Name (Legal Business Name): FIRSTHAND HEALTH OF WASHINGTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 BROADWAY STE 200
TACOMA WA
98402-3500
US

IV. Provider business mailing address

524 BROADWAY FL 11
NEW YORK NY
10012-4471
US

V. Phone/Fax

Practice location:
  • Phone: 201-474-5844
  • Fax: 877-804-1324
Mailing address:
  • Phone: 844-378-4263
  • Fax: 855-384-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH J PARKS
Title or Position: CHIEF MEDICAL DIRETOR
Credential: MD
Phone: 781-718-5377