Provider Demographics
NPI:1053656215
Name:PHYSICIANS FAMILY HEALTH SERV INC
Entity Type:Organization
Organization Name:PHYSICIANS FAMILY HEALTH SERV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUARDARRAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-222-1142
Mailing Address - Street 1:600 W 111TH ST
Mailing Address - Street 2:SUITEN 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1813
Mailing Address - Country:US
Mailing Address - Phone:212-222-1142
Mailing Address - Fax:212-222-1142
Practice Address - Street 1:600 W 111TH ST
Practice Address - Street 2:SUITEN 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1813
Practice Address - Country:US
Practice Address - Phone:212-222-1142
Practice Address - Fax:212-222-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty