Organization
PERFORMANCE MEDICAL PRAACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN PHILLIPS MD (OWNER)
(347) 813-0535
Entity
Organization
Contact information
Practice address
160 E 56TH ST, 3RD FLOOR, NEW YORK, NY 10011
(646) 866-6076
(917) 261-7912
Mailing address
160 E 56TH ST, 3RD FLOOR, NEW YORK, NY 10011
(646) 866-6076
(917) 281-7912
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
284515
NY
208VP0000X
Pain Medicine Physician
Primary
284515
NY
Other
Enumeration date
08/21/2018
Last updated
08/21/2018
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