=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629112396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID HOM MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 E 33RD ST LL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-683-1008
-----------------------------------------------------
Fax | 212-683-2199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 E 33RD ST LL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-4804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-683-1008
-----------------------------------------------------
Fax | 212-683-2199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. DAVID HOM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-683-1008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 205838 1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------