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General NPI Number Information
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NPI Number | 1447291299
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Entity Type | Organization
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Legal Business Name | DOWNTOWN PRIMARY CARE LLP
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 80 MAIDEN LN RM 1902
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City | NEW YORK
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State | NY
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Zip | 10038-4773
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Country | US
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Telephone | 212-379-6480
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Fax |
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Provider Business Mailing Address
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Address Line | 80 MAIDEN LN RM 1901
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City | NEW YORK
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State | NY
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Zip | 10038-4717
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Country | US
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Telephone | 212-793-6480
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. REGINA WAGNER JANICIK
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Credential | MD
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Telephone | 212-379-6480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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