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General NPI Number Information
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NPI Number | 1669804100
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Entity Type | Organization
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Legal Business Name | NEW YORK PHYSICIAN PLLC
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 535 5TH AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10017-8020
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Country | US
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Telephone | 628-260-5154
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Fax | 855-691-0403
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Provider Business Mailing Address
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Address Line | 535 5TH AVE FL 4
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City | NEW YORK
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State | NY
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Zip | 10017-8020
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Country | US
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Telephone | 888-970-3777
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Fax | 888-970-3777
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Authorized Official
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Title or Position | OWNER
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Name | DR. SEKULEO GATHERS
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Credential | M.D.
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Telephone | 888-970-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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