Provider Demographics
NPI:1174963334
Name:SOHO CENTER FOR TRAVEL HEALTH
Entity type:Organization
Organization Name:SOHO CENTER FOR TRAVEL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-601-0757
Mailing Address - Street 1:270 LAFAYETTE ST
Mailing Address - Street 2:SUITE 1209
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3311
Mailing Address - Country:US
Mailing Address - Phone:917-601-0757
Mailing Address - Fax:347-348-0682
Practice Address - Street 1:270 LAFAYETTE ST
Practice Address - Street 2:SUITE 1209
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3311
Practice Address - Country:US
Practice Address - Phone:917-601-0757
Practice Address - Fax:347-348-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245123261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service