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General NPI Number Information
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NPI Number | 1730136342
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Entity Type | Organization
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Legal Business Name | 501 WEST MEDICAL, P.C.
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 501 W 145TH ST SUITE 3
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City | NEW YORK
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State | NY
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Zip | 10031-5132
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Country | US
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Telephone | 646-526-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 501 W 145TH ST SUITE 3
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City | NEW YORK
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State | NY
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Zip | 10031-5132
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Country | US
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Telephone | 646-526-3641
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DR. KIM MYRUTH NICHOLS
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Credential | M.D.
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Telephone | 646-526-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 60-239556
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License Number State | NY
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