=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477148294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINSTON FAMILY HEALTH NP P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2021
-----------------------------------------------------
Last Update Date | 03/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 W 51ST ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-6419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-801-0415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 MARINE PLZ STE 306
-----------------------------------------------------
City | NORTH BERGEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07047-6238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IDIR SARADOUNI
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 201-992-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------