Provider Demographics
NPI:1124316690
Name:GVPDO MEDICINE PC
Entity type:Organization
Organization Name:GVPDO MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VASCONEZ PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-929-3334
Mailing Address - Street 1:231 W 15TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6433
Mailing Address - Country:US
Mailing Address - Phone:212-929-3334
Mailing Address - Fax:
Practice Address - Street 1:20 W 38TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6228
Practice Address - Country:US
Practice Address - Phone:212-768-1600
Practice Address - Fax:212-768-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty