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General NPI Number Information
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NPI Number | 1295890069
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Entity Type | Organization
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Legal Business Name | COLISEUM SURGICAL & MEDICAL PC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 30 W 60TH ST SUITE 1H
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City | NEW YORK
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State | NY
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Zip | 10023-7906
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Country | US
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Telephone | 212-247-6575
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Fax | 212-582-9461
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Provider Business Mailing Address
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Address Line | 503 AIRPORT EXECUTIVE PARK
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City | NANUET
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State | NY
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Zip | 10954-5238
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Country | US
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Telephone | 845-426-6864
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Fax | 845-356-5312
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Authorized Official
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Title or Position | SURGEON
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Name | DR. ERIC MOORE
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Credential | MD
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Telephone | 212-247-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 153732
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License Number State | NY
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