=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629421300
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HEALTH MEDICAL C&D PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2016
-----------------------------------------------------
Last Update Date | 07/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 FULTON ST RM 201
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10038-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-544-3438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 660 SOLDIER HILL RD
-----------------------------------------------------
City | ORADELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07649-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-544-3438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DR. STEVE HOODY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 844-544-3438
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 193456
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------