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General NPI Number Information
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NPI Number | 1144300070
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE HEALTH SERVICE
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | 3009 BROADWAY PRIMARY CARE HEALTH SERVICE
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City | NEW YORK
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State | NY
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Zip | 10027-6598
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Country | US
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Telephone | 212-854-2019
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Fax | 212-854-2702
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Provider Business Mailing Address
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Address Line | 3009 BROADWAY PRIMARY CARE HEALTH SERVICE
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City | NEW YORK
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State | NY
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Zip | 10027-6598
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Country | US
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Telephone | 212-854-2019
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Fax | 212-854-2702
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARJORIE K SEIDENFELD
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Credential | M.D.
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Telephone | 212-854-2019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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