Provider Demographics
NPI:1053611269
Name:JUDITH MORRIS DE CELIS MD PC
Entity type:Organization
Organization Name:JUDITH MORRIS DE CELIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS DE CELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-679-2213
Mailing Address - Street 1:330 E 38TH ST APT 31J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2781
Mailing Address - Country:US
Mailing Address - Phone:917-940-7258
Mailing Address - Fax:917-388-2678
Practice Address - Street 1:338 E 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8318
Practice Address - Country:US
Practice Address - Phone:212-679-2213
Practice Address - Fax:917-388-2678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134562207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09669Medicare UPIN
NY42A031Medicare PIN