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General NPI Number Information
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NPI Number | 1619570108
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Entity Type | Organization
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Legal Business Name | LADY MEDICAL PLLC
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 1309 5TH AVE APT 2E
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City | NEW YORK
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State | NY
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Zip | 10029-3145
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Country | US
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Telephone | 860-380-0487
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 5TH AVE APT 2E
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City | NEW YORK
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State | NY
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Zip | 10029-3145
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Country | US
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Telephone | 860-380-0487
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CANDICE FRASER
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Credential | MD
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Telephone | 860-380-0487
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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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