Provider Demographics
NPI:1336585314
Name:TAKE CARE MEDICAL HEALTH NEW YORK, PC
Entity Type:Organization
Organization Name:TAKE CARE MEDICAL HEALTH NEW YORK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICIAL/AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-925-4733
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 640
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:855-925-4733
Mailing Address - Fax:217-709-2345
Practice Address - Street 1:1627 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7407
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:217-709-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty