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General NPI Number Information
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NPI Number | 1700429784
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Entity Type | Organization
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Legal Business Name | JAMES A UNDERBERG MD PLLC
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 110 E 55TH ST FL 9
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City | NEW YORK
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State | NY
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Zip | 10022-4540
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Country | US
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Telephone | 212-207-1959
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Fax | 855-860-3844
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Provider Business Mailing Address
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Address Line | 136 E 56TH ST APT 9A
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City | NEW YORK
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State | NY
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Zip | 10022-0901
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Country | US
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Telephone | 212-207-1959
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Fax | 914-761-2591
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Authorized Official
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Title or Position | PROPRIETOR/OWNER
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Name | JAMES A UNDERBERG
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Credential | MD
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Telephone | 917-880-1420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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