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General NPI Number Information
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NPI Number | 1578753554
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Entity Type | Organization
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Legal Business Name | NEW YORK COLORECTAL CARE LLC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 133 EAST 58TH STREET #304
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 212-688-2100
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Fax | 212-688-2136
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Provider Business Mailing Address
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Address Line | 133 EAST 58TH STREET #304
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City | NEW YORK
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State | NY
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Zip | 10022
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Country | US
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Telephone | 212-688-2100
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Fax | 212-688-2136
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Authorized Official
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Title or Position | MEMBER
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Name | DR. NICOLE J KAFKA
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Credential | MD
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Telephone | 212-688-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1811531
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License Number State | NY
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