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Organization
STATEN ISLAND PHYSICIAN PRACTICE PC
Active
Organization
STATEN ISLAND PHYSICIAN PRACTICE PC
Active
Other names
AdvantageCare Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENA SIMPSON CPMSM (AVP - CREDENTIALING)
(646) 680-2894
Entity
Organization
Contact information
Practice address
441 9TH AVE, 9TH FLOOR, NEW YORK, NY 10001-1623
(646) 680-2894
Mailing address
441 9TH AVE, 9TH FLOOR, NEW YORK, NY 10001-1623
(646) 680-2894
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02769859
—
NY
Enumeration date
05/16/2006
Last updated
12/01/2015
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