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General NPI Number Information
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NPI Number | 1629570577
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Entity Type | Organization
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Legal Business Name | 424 MADISON AVENUE INC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 424 MADISON AVE FL 15
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City | NEW YORK
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State | NY
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Zip | 10017-1158
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Country | US
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Telephone | 212-753-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 424 MADISON AVE FL 15
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City | NEW YORK
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State | NY
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Zip | 10017-1158
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Country | US
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Telephone | 212-753-7400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANK DICICCO
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Credential | DMD
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Telephone | 212-753-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State | NY
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