Provider Demographics
NPI:1407187917
Name:MEDCOR INC.
Entity Type:Organization
Organization Name:MEDCOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY ANNE
Authorized Official - Middle Name:JUSTINE
Authorized Official - Last Name:REXACH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, MSN, FNP-C
Authorized Official - Phone:212-664-4444
Mailing Address - Street 1:30 ROCKEFELLER PLZ
Mailing Address - Street 2:SUITE 754S -9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10112-0015
Mailing Address - Country:US
Mailing Address - Phone:212-664-4444
Mailing Address - Fax:
Practice Address - Street 1:30 ROCKEFELLER PLZ
Practice Address - Street 2:SUITE 754S-9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10112-0015
Practice Address - Country:US
Practice Address - Phone:212-664-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF33677-1261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine