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General NPI Number Information
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NPI Number | 1043451115
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Entity Type | Organization
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Legal Business Name | DEVONSHIRE SURGICAL FACILITY, LLC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 57 W 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 212-838-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 57 W 57TH ST
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City | NEW YORK
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State | NY
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Zip | 10019-2802
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Country | US
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Telephone | 212-838-8196
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GLENN WEISS
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Credential | DPM
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Telephone | 212-838-8196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 235963
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License Number State | NY
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