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General NPI Number Information
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NPI Number | 1730577602
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Entity Type | Organization
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Legal Business Name | NICSEB MEDICAL PC
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Dates
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Enumeration Date | 12/31/2014
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 103 W 117TH ST PH
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City | NEW YORK
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State | NY
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Zip | 10026-2963
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Country | US
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Telephone | 917-664-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 103 W 117TH ST PH
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City | NEW YORK
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State | NY
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Zip | 10026-2963
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA PALIOU
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Credential |
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Telephone | 917-664-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 263301
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License Number State | NY
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