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General NPI Number Information
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NPI Number | 1548677883
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Entity Type | Organization
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Legal Business Name | SENIOR WHOLE HEALTH OF NEW YORK, INC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 111 BROADWAY RM 1505
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City | NEW YORK
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State | NY
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Zip | 10006-1926
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Country | US
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Telephone | 617-494-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 58 CHARLES ST
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City | CAMBRIDGE
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State | MA
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Zip | 02141-2128
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Country | US
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Telephone | 617-494-5353
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. THURMAN JUSTICE
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Credential |
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Telephone | 617-494-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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