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General NPI Number Information
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NPI Number | 1174963334
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Entity Type | Organization
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Legal Business Name | SOHO CENTER FOR TRAVEL HEALTH
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 270 LAFAYETTE ST SUITE 1209
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City | NEW YORK
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State | NY
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Zip | 10012-3311
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Country | US
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Telephone | 917-601-0757
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Fax | 347-348-0682
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Provider Business Mailing Address
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Address Line | 270 LAFAYETTE ST SUITE 1209
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City | NEW YORK
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State | NY
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Zip | 10012-3311
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Country | US
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Telephone | 917-601-0757
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Fax | 347-348-0682
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | STEFAN HAGMANN
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Credential | M.D.
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Telephone | 917-601-0757
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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 | 245123
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License Number State | NY
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