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General NPI Number Information
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NPI Number | 1851554851
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Entity Type | Organization
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Legal Business Name | VILLAGE HEALTH CARE CLINIC
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 121 A WEST 20TH ST VILLAGE DIAGNOSTIC AND TREATMENT CENTER
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City | NEW YORK
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State | NY
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Zip | 10011
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Country | US
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Telephone | 212-337-9290
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Fax |
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Provider Business Mailing Address
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Address Line | 240 1ST AVE SUITE#C
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City | NEW YORK
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State | NY
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Zip | 10009-2601
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Country | US
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Telephone | 212-982-2075
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LAWRENCE GEORGE HITZEMAN
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Credential | MD
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Telephone | 212-337-9290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 206313
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License Number State | NY
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