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General NPI Number Information
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NPI Number | 1730259581
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Entity Type | Organization
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Legal Business Name | ST. VINCENT'S 52ND ST. MEDICAL PRACTICE, PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 355 W 52ND ST 7TH FL
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City | NEW YORK
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State | NY
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Zip | 10019-6239
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Country | US
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Telephone | 646-778-5546
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Fax |
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Provider Business Mailing Address
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Address Line | 355 W 52ND ST 7TH FL
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City | NEW YORK
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State | NY
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Zip | 10019-6239
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Country | US
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Telephone | 646-778-5546
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GERALD I LEICHMAN
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Credential | MD
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Telephone | 696-778-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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