=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699296632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A1 MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 FIFTH AVE 4 FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-733-6222
-----------------------------------------------------
Fax | 646-304-2171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 5TH AVE FL 4
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-8020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-733-6222
-----------------------------------------------------
Fax | 646-304-2171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ANTONIO PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-733-6222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------