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General NPI Number Information
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NPI Number | 1851910319
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Entity Type | Organization
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Legal Business Name | STATUE TC LLC
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 900 BROADWAY STE 203
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City | NEW YORK
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State | NY
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Zip | 10003-1241
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Country | US
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Telephone | 212-949-0393
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Fax | 212-949-0396
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Provider Business Mailing Address
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Address Line | 477 MADISON AVE STE 410
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City | NEW YORK
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State | NY
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Zip | 10022-5818
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Country | US
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Telephone | 516-972-7075
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Fax | 516-407-2911
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Authorized Official
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Title or Position | PRESIDENT
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Name | OMAR NOOR
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Credential | MD
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Telephone | 212-949-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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