Provider Demographics
NPI:1851910319
Name:STATUE TC LLC
Entity Type:Organization
Organization Name:STATUE TC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-949-0393
Mailing Address - Street 1:477 MADISON AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5818
Mailing Address - Country:US
Mailing Address - Phone:516-972-7075
Mailing Address - Fax:516-407-2911
Practice Address - Street 1:900 BROADWAY STE 203
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1241
Practice Address - Country:US
Practice Address - Phone:212-949-0393
Practice Address - Fax:212-949-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty