# FORDHAM PROFESSIONAL MEDICAL SERVICES OF NEW YORK LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124524970
- **Authorized official:** YAN KATSNELSON M.D. (OWNER)
- **Authorized official phone:** (224) 318-0118

## Contact information

- **Practice address:** 11 E FORDHAM RD STE A, BRONX, NY 10468-5406
- **Practice address phone:** (847) 593-8460
- **Practice address fax:** (224) 235-4652
- **Mailing address:** 304 WAINWRIGHT DR STE 110, NORTHBROOK, IL 60062-1919
- **Mailing address phone:** (224) 318-0118
- **Mailing address fax:** (224) 235-4652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/02/2018
- **Last updated:** 04/02/2018