MEDICARE: SOHO COMMUNITY CLINIC

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	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1174563548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOHO COMMUNITY CLINIC

Provider Business Mailing Address
First Line	:	245 W HOUSTON ST
Second Line	:	ROOM 313
City	:	NEW YORK
State	:	NY
Zip	:	10014-4805
Country	:	US
Telephone Number	:	212-337-2569
Fax Number	:	212-337-2537

Provider Business Practice Location Address
First Line	:	245 W HOUSTON ST
Second Line	:	ROOM 313
City	:	NEW YORK
State	:	NY
Zip	:	10014-4805
Country	:	US
Telephone Number	:	212-337-2569
Fax Number	:	212-337-2537

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS DEVELOPMENT
Name	:	BARBARA MAYERICK
Credential	:
Telephone Number	:	202-254-0339

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/22/2020

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Directions to “SOHO COMMUNITY CLINIC ” Practice Location

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