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General NPI Number Information
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NPI Number | 1497570907
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Entity Type | Organization
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Legal Business Name | NEW YORK DIRECT MEDICAL PLLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 979 ULSTER HEIGHTS RD
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City | ELLENVILLE
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State | NY
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Zip | 12428-5746
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Country | US
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Telephone | 718-795-4443
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Fax |
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Provider Business Mailing Address
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Address Line | 979 ULSTER HEIGHTS RD
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City | ELLENVILLE
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State | NY
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Zip | 12428-5746
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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 | MD
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Name | ALEXANDER ROTH
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Credential |
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Telephone | 718-250-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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