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General NPI Number Information
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NPI Number | 1083069439
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 745 5TH AVE SUITE 500
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City | NEW YORK
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State | NY
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Zip | 10151-0099
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Country | US
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Telephone | 646-898-2037
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Fax |
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Provider Business Mailing Address
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Address Line | 745 5TH AVE SUITE 500
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City | NEW YORK
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State | NY
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Zip | 10151-0099
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Country | US
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Telephone | 646-898-2037
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CHARLES Y JIN
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Credential | M.D.
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Telephone | 646-898-2037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 101838
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License Number State | NY
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