=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275231722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 645 MEDICAL ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2023
-----------------------------------------------------
Last Update Date | 02/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 MADISON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-857-4537
-----------------------------------------------------
Fax | 940-209-2366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 645 MADISON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-857-4537
-----------------------------------------------------
Fax | 940-209-2366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | ALANA LEVINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-657-2400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------