Provider Demographics
NPI:1851554851
Name:VILLAGE HEALTH CARE CLINIC
Entity Type:Organization
Organization Name:VILLAGE HEALTH CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HITZEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-337-9290
Mailing Address - Street 1:240 1ST AVE
Mailing Address - Street 2:SUITE#C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2601
Mailing Address - Country:US
Mailing Address - Phone:212-982-2075
Mailing Address - Fax:
Practice Address - Street 1:121 A WEST 20TH ST
Practice Address - Street 2:VILLAGE DIAGNOSTIC AND TREATMENT CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-337-9290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206313261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH52340Medicare UPIN