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General NPI Number Information
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NPI Number | 1306021274
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Entity Type | Organization
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Legal Business Name | BACK AND BODY MEDICAL CARE, P.C.
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 133 E 58TH ST SUITE 708
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City | NEW YORK
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State | NY
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Zip | 10022-1236
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Country | US
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Telephone | 212-371-2000
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Fax | 212-371-2250
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Provider Business Mailing Address
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Address Line | 133 E 58TH ST SUITE 708
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City | NEW YORK
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State | NY
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Zip | 10022-1236
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Country | US
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Telephone | 212-371-2000
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Fax | 212-371-2250
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAN SIVENDRA
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Credential | M.D.
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Telephone | 212-371-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 245922-1
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License Number State | NY
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