Basic Information
| Provider Information | |||||||||
| NPI: | 1699901280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CITICARE,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 154 W 127TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100273722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127493507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 154 W 127TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100273722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127493507 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2009 | ||||||||
| LastUpdateDate: | 06/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | WENDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2127493507 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 000462 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.