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General NPI Number Information
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NPI Number | 1225238736
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Entity Type | Organization
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Legal Business Name | HEALTHBAY MEDICAL, PC
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 156 NAGLE AVE - 2ND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10040-1436
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Country | US
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Telephone | 718-841-2610
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Fax | 718-841-2611
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Provider Business Mailing Address
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Address Line | 156 NAGLE AVE - 2ND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10040-1436
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Country | US
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Telephone | 718-841-2610
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Fax | 718-841-2611
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Authorized Official
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Title or Position | MD
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Name | DR. IROKU A HUMPHREY
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Credential | MD
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Telephone | 718-841-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 125949-1
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License Number State | NY
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