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General NPI Number Information
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NPI Number | 1083814974
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Entity Type | Organization
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Legal Business Name | NEW YORK WALK-IN MEDICAL GROUP, PC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 1627 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10019-7407
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Country | US
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Telephone | 866-366-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 11 PENN PLAZA SUITE 500
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 866-366-3060
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL JAMES ENDRES
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Credential | M.D.
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Telephone | 202-955-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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