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General NPI Number Information
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NPI Number | 1407729940
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Entity Type | Organization
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Legal Business Name | 61-3 MEDICAL PC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1041 3RD AVE, 2ND FL
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City | NEW YORK
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State | NY
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Zip | 10065-8114
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Country | US
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Telephone | 212-362-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 3RD AVE, 2ND FL
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City | NEW YORK
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State | NY
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Zip | 10065-8114
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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 | ADMINISTRATIVE ASSISTANT
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Name | CRYSTAL TOUSSAINT
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Credential |
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Telephone | 212-362-3470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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