Provider Demographics
NPI:1003121492
Name:PERFORMANCE MEDICAL SERVICES
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-486-8616
Mailing Address - Street 1:70 E 55TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3222
Mailing Address - Country:US
Mailing Address - Phone:212-486-8616
Mailing Address - Fax:212-486-8621
Practice Address - Street 1:570 LEXINGTON AVE
Practice Address - Street 2:SUITE 1903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6837
Practice Address - Country:US
Practice Address - Phone:212-486-8616
Practice Address - Fax:212-486-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005160-2111N00000X
NY229782-A171100000X
NY241676-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty