Basic Information
| Provider Information | |||||||||
| NPI: | 1184762718 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1041 3RD AVE | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100658114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123623470 | ||||||||
| FaxNumber: | 2123623496 | ||||||||
| Practice Location | |||||||||
| Address1: | 1041 3RD AVE | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100658114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123623470 | ||||||||
| FaxNumber: | 2123623496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2007 | ||||||||
| LastUpdateDate: | 07/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 190363 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01892846 | 05 | NY | MEDICAID |