MEDICARE: GRAMAERCY PARK MEDICAL GROUP

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	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1396843967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAMAERCY PARK MEDICAL GROUP

Provider Business Mailing Address
First Line	:	253 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-7401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 3RD AVE # 55
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-7401
Country	:	US
Telephone Number	:	212-475-1900
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	FELICITAS AMADOR
Credential	:
Telephone Number	:	212-475-1900

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “GRAMAERCY PARK MEDICAL GROUP ” Practice Location

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