MEDICARE: PRIMARY CARE HEALTH SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1144300070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE HEALTH SERVICE

Provider Business Mailing Address
First Line	:	3009 BROADWAY
Second Line	:	PRIMARY CARE HEALTH SERVICE
City	:	NEW YORK
State	:	NY
Zip	:	10027-6598
Country	:	US
Telephone Number	:	212-854-2019
Fax Number	:	212-854-2702

Provider Business Practice Location Address
First Line	:	3009 BROADWAY
Second Line	:	PRIMARY CARE HEALTH SERVICE
City	:	NEW YORK
State	:	NY
Zip	:	10027-6598
Country	:	US
Telephone Number	:	212-854-2019
Fax Number	:	212-854-2702

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MARJORIE K SEIDENFELD
Credential	:	M.D.
Telephone Number	:	212-854-2019

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/28/2012

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