Provider Demographics
NPI:1407899339
Name:WARE, PRISCILLA (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 9TH AVE
Mailing Address - Street 2:CREDENTIALING 3RD FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1623
Mailing Address - Country:US
Mailing Address - Phone:646-680-2894
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:4337 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2411
Practice Address - Country:US
Practice Address - Phone:212-568-6300
Practice Address - Fax:516-542-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136581208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00896135Medicaid
NY92A757Z761Medicare PIN
NYA400121594Medicare PIN
NYA64809Medicare UPIN