Nyc Broadway Health LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

NYC BROADWAY HEALTH LLC

Practice address

111 Broadway
Suite 1303
New York, NY 10006-1901

Phone

(914) 376-6100

Fax

(914) 470-5056

NPI assigned

Feb 16, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ivan Darrio Baraque, MD

Title

Medical Director

Phone

(914) 376-6100

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1912366147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BROADWAY",
            "address_2": "SUITE 1303",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061901",
            "telephone_number": "914-376-6100",
            "fax_number": "914-470-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BROADWAY",
            "address_2": "SUITE 1303",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061901",
            "telephone_number": "914-376-6100",
            "fax_number": "914-470-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NYC BROADWAY HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-16",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "BARAQUE",
        "authorized_official_first_name": "IVAN",
        "authorized_official_middle_name": "DARRIO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "914-376-6100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in New York, NY
• Providers in New York, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.