| A.w Medical Office, P.c | |
|
1624 University Ave. Bronx NY 10453-6948 | |
| (718) 294-4008 | |
| (718) 294-9466 |
| Full Name | A.w Medical Office, P.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 1624 University Ave., Bronx, New York |
| Authorized Official Name and Position | Ramon Modesto Tallaj (PHYSICIAN) |
| Authorized Official Contact | 7182944008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A.w Medical Office, P.c 571 Academy St Ste Gle New York NY 10034-5104 Ph: (212) 567-0550 | A.w Medical Office, P.c 1624 University Ave. Bronx NY 10453-6948 Ph: (718) 294-4008 |
| NPI Number | 1235316563 |
|---|---|
| Provider Enumeration Date | 01/29/2008 |
| Last Update Date | 05/15/2012 |
| Medicare PECOS PAC ID | 8628098365 |
|---|---|
| Medicare Enrollment ID | O20051128000238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235316563 | NPI | - | NPPES |
| 639AH1 | Other | NY | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 204704 (New York) | Primary |
| Provider Name | Ramon M Tallaj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487753497 PECOS PAC ID: 7416986617 Enrollment ID: I20050808001216 |
| Provider Name | Emilio I Perez |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1912149915 PECOS PAC ID: 0840343521 Enrollment ID: I20090728000459 |
| Provider Name | Pedro Rafael Castillo Tallaj |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487129227 PECOS PAC ID: 9335510585 Enrollment ID: I20230125002988 |
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