| Adolescent Health And Wellness Center | |
|
960 Southern Blvd Bronx NY 10459-3402 | |
| (718) 589-2440 | |
| (718) 991-4516 |
| Full Name | Adolescent Health And Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 960 Southern Blvd, Bronx, New York |
| Authorized Official Name and Position | Samuel Deleon (VP MEDICAL AFFAIRS/CMO) |
| Authorized Official Contact | 7185892440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Adolescent Health And Wellness Center 1065 Southern Blvd Bronx NY 10459-2417 Ph: (718) 589-2440 | Adolescent Health And Wellness Center 960 Southern Blvd Bronx NY 10459-3402 Ph: (718) 589-2440 |
| NPI Number | 1699072686 |
|---|---|
| Provider Enumeration Date | 02/28/2011 |
| Last Update Date | 07/24/2012 |
| Medicare PECOS PAC ID | 3173517281 |
|---|---|
| Medicare Enrollment ID | O20110323000002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699072686 | NPI | - | NPPES |
| 331015 | Other | NY | SITE MEDICARE ID # |
| 02994952 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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