Provider Demographics
NPI:1861895070
Name:AGNES H WHITAKER MD PC
Entity type:Organization
Organization Name:AGNES H WHITAKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-692-8297
Mailing Address - Street 1:15 W 72ND ST
Mailing Address - Street 2:SUITE 1P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3402
Mailing Address - Country:US
Mailing Address - Phone:646-692-8297
Mailing Address - Fax:646-692-8302
Practice Address - Street 1:15 W 72ND ST
Practice Address - Street 2:SUITE 1P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3402
Practice Address - Country:US
Practice Address - Phone:646-692-8297
Practice Address - Fax:646-692-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137109-12084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty