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General NPI Number Information
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NPI Number | 1740801018
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Entity Type | Organization
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Legal Business Name | PERFORMANCE MEDICAL OFFICE PLLC
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 70 E 55TH ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10022-3396
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Country | US
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Telephone | 516-388-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 LAKEVILLE RD STE 2
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1639
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Country | US
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Telephone | 516-388-5110
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Fax | 516-517-9515
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. MARVELL SCOTT
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Credential |
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Telephone | 212-203-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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