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NPI Code Detail

MEDICARE: NY COMPREHENSIVE MEDICAL WELLNESS P.C.

MEDICARE: NY COMPREHENSIVE MEDICAL WELLNESS 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
1207ND0900XDermatopathology Physician288165NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1115644OTHERNYNYSED ID

General Provider Information

NPI Number : 1912419698
Entity Type Code : Organization
Provider Name (Legal Business Name) : NY COMPREHENSIVE MEDICAL WELLNESS P.C.
Provider Business Mailing Address
First Line : 2 S END AVE APT TH8
Second Line :
City : NEW YORK
State : NY
Zip : 10280-1089
Country : US
Telephone Number : 830-331-9900
Fax Number :
Provider Business Practice Location Address
First Line : 329 E 149TH ST
Second Line :
City : BRONX
State : NY
Zip : 10451-5625
Country : US
Telephone Number : 718-585-5500
Fax Number : 718-585-5502
Authorized Official
Title or Position : MANAGING EMPLOYEE
Name : MICHAEL SORACE
Credential : MD
Telephone Number : 830-331-9900
Provider Enumeration Date : 11/02/2017
Last Update Date : 11/02/2017

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