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General NPI Number Information
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NPI Number | 1457801649
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Entity Type | Organization
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Legal Business Name | HARLEM PHYSICIAN GROUP
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 53 E 124TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-1815
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Country | US
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Telephone | 212-602-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 53 E 124TH ST
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City | NEW YORK
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State | NY
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Zip | 10035-1815
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Country | US
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Telephone | 212-602-9199
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BIJAN SAFAI
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Credential |
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Telephone | 212-602-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 271244
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License Number State | NY
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