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Organization
EXCELSIOR EMPIREHEALTH IPA, LLC
Active
Organization
EXCELSIOR EMPIREHEALTH IPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIKI WONG (CREDENTIALING SPECIALIST)
(718) 888-9579
Entity
Organization
Contact information
Practice address
94 BOWERY, NEW YORK, NY 10013-4888
(212) 335-0320
Mailing address
94 BOWERY, NEW YORK, NY 10013-4888
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
207W00000X
Ophthalmology Physician
—
NULL
207W00000X
Ophthalmology Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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