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General NPI Number Information
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NPI Number | 1356128086
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Entity Type | Organization
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Legal Business Name | EVENTIDE LOGOS LLC
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 535 5TH AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10017-8020
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Country | US
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Telephone | 718-734-9000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 286500
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City | NEW YORK
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State | NY
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Zip | 10128-0005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | HAYLEY VOIERS
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Credential |
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Telephone | 718-734-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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