=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770885808
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URGENT CARE PHYSICIAN OF NEW YORK-HARTSDALE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2010
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 843 HUTCHINSON RIVER PKWY
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10465-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-925-4400
-----------------------------------------------------
Fax | 718-684-1310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 843 HUTCHINSON RIVER PKWY
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10465-1818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-925-4400
-----------------------------------------------------
Fax | 718-684-1310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | VICKI PURUGGANAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 413-426-7665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------