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General NPI Number Information
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NPI Number | 1487254041
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Entity Type | Organization
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Legal Business Name | HEALTHY THERAPEUTICS MEDICAL PRACTICE PLLC
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 36 SAINT JOHNS PL
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City | BROOKLYN
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State | NY
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Zip | 11217-3206
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Country | US
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Telephone | 678-381-5170
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Fax |
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Provider Business Mailing Address
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Address Line | 36 SAINT JOHNS PL
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City | BROOKLYN
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State | NY
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Zip | 11217-3206
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Country | US
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Telephone | 678-381-5170
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. RONDALPH SAMUEL TAYLOR JR.
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Credential | MD
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Telephone | 678-381-5170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | 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 | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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