Provider Demographics
NPI:1700558798
Name:IVY MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:IVY MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FUNSCH
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:929-373-4449
Mailing Address - Street 1:885 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4834
Mailing Address - Country:US
Mailing Address - Phone:305-771-4986
Mailing Address - Fax:305-771-4986
Practice Address - Street 1:701 BRICKELL KEY BLVD APT 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2675
Practice Address - Country:US
Practice Address - Phone:305-771-4986
Practice Address - Fax:305-771-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty