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General NPI Number Information
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NPI Number | 1376297721
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Entity Type | Organization
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Legal Business Name | HYDRATE MEDICAL PLLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 4 W 125TH ST
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City | NEW YORK
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State | NY
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Zip | 10027-4567
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Country | US
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Telephone | 917-584-5605
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 PURCHASE ST UNIT 616
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City | PURCHASE
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State | NY
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Zip | 10577-7551
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Country | US
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Telephone | 917-584-5605
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANNE NEGRIN
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Credential | MD
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Telephone | 917-584-5605
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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 |
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License Number State |
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