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General NPI Number Information
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NPI Number | 1841375029
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Entity Type | Organization
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Legal Business Name | TRINITY MEDICAL GROUP PC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 104 VERMILYEA AVE SUITE B
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City | NEW YORK
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State | NY
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Zip | 10034-3209
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Country | US
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Telephone | 212-544-8854
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Fax | 845-230-2346
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Provider Business Mailing Address
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Address Line | 104 VERMILYEA AVE SUITE B
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City | NEW YORK
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State | NY
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Zip | 10034-3209
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Country | US
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Telephone | 212-544-8854
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Fax | 845-230-2346
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Authorized Official
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Title or Position | CEO
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Name | DR. STEVE TENI AYANRUOH
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Credential | MD
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Telephone | 212-544-8854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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