Provider Demographics
NPI:1588452379
Name:HIGH LINE MODERN MEDICINE
Entity type:Organization
Organization Name:HIGH LINE MODERN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-681-1211
Mailing Address - Street 1:420 W 23RD ST APT AGF
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2100
Mailing Address - Country:US
Mailing Address - Phone:646-681-1211
Mailing Address - Fax:646-607-2616
Practice Address - Street 1:420 W 23RD ST APT AGF
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2100
Practice Address - Country:US
Practice Address - Phone:646-681-1211
Practice Address - Fax:646-607-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty