MEDICARE: PERFORMANCE MEDICAL OF NY, P.C.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1164398137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERFORMANCE MEDICAL OF NY, P.C.

Provider Business Mailing Address
First Line	:	531 W 26TH ST FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-5514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 W 26TH ST FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-5514
Country	:	US
Telephone Number	:	855-621-2061
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	ALEX MATHER
Credential	:
Telephone Number	:	855-621-2061

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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