=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639699648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE EXECU-SEARCH GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 675 3RD AVE FL 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-5731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-204-5140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 3RD AVE FL 5
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-5731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-204-5140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING DIRECTOR OF COMPLIANCE
-----------------------------------------------------
Name | MR. JAMES C. DOLAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-204-5140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------