=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801540919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CKM MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2022
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 E 60TH ST RM 802
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-760-3256
-----------------------------------------------------
Fax | 646-974-9714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 E 60TH ST RM 802
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-760-3256
-----------------------------------------------------
Fax | 646-974-9714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CAROLINE MESSER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 646-760-3256
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------