Organization
NYC BROADWAY HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVAN DARRIO BARAQUE MD (MEDICAL DIRECTOR)
(914) 376-6100
Entity
Organization
Contact information
Practice address
111 BROADWAY, SUITE 1303, NEW YORK, NY 10006-1901
(914) 376-6100
(914) 470-5056
Mailing address
111 BROADWAY, SUITE 1303, NEW YORK, NY 10006-1901
(914) 376-6100
(914) 470-5056
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
02/16/2016
Last updated
02/16/2016
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