Basic Information
| Provider Information | |||||||||
| NPI: | 1396230777 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LUXURGERY 880 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 880 FIFTH AVENUE | ||||||||
| Address2: | #1B/C/D | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125080000 | ||||||||
| FaxNumber: | 2125080005 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 FIFTH AVENUE | ||||||||
| Address2: | #1B/C/D | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125080000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2018 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | SHRIDHARANI | ||||||||
| AuthorizedOfficialFirstName: | SACHIN | ||||||||
| AuthorizedOfficialMiddleName: | MAHAVIR | ||||||||
| AuthorizedOfficialTitleorPosition: | FACILITY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2125080000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.