=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346691003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHELPS MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2016
-----------------------------------------------------
Last Update Date | 06/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 SAINT NICHOLAS AVE APT.7M
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-7620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-337-2852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 SAINT NICHOLAS AVE APT.7M
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-7620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-337-2852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. CHRISTIAN G GONZALEZ
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 786-337-2852
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------