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1733 Eastchester Rd Bronx NY 10461-2315 | |
| (516) 551-6317 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1733 Eastchester Rd, Bronx, New York |
| Authorized Official Name and Position | Robert Lynn (SHARE HOLDER) |
| Authorized Official Contact | 5165516317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1200 Waters Pl Suite M104 Bronx NY 10461-2728 Ph: (718) 794-1200 | 1733 Eastchester Rd Bronx NY 10461-2315 Ph: (516) 551-6317 |
| NPI Number | 1689014987 |
|---|---|
| Provider Enumeration Date | 07/01/2013 |
| Last Update Date | 10/29/2013 |
| Medicare PECOS PAC ID | 4082849716 |
|---|---|
| Medicare Enrollment ID | O20131104001674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689014987 | NPI | - | NPPES |
| Provider Name | Gary A Tannenbaum |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1811949670 PECOS PAC ID: 8527022698 Enrollment ID: I20041117001271 |
| Provider Name | Alan J Boykin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1154396869 PECOS PAC ID: 1052345451 Enrollment ID: I20050926000042 |
| Provider Name | Amit R Shah |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1396067682 PECOS PAC ID: 1355524588 Enrollment ID: I20110325000646 |
| Provider Name | Zaher Hamadeh |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1043226251 PECOS PAC ID: 9335146489 Enrollment ID: I20120319000376 |
| Provider Name | Bashar Ericsoossi |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1437312758 PECOS PAC ID: 1355569609 Enrollment ID: I20160120001834 |
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