| |
890 Hunts Point Ave Bronx NY 10474-5402 | |
(718) 589-2440 | |
(718) 589-4793 |
Full Name | |
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Speciality | Clinic/Center |
Location | 890 Hunts Point Ave, Bronx, New York |
Authorized Official Name and Position | Alexandra Borbon (DIRECTOR, MANAGED CARE OFFICE, CONT) |
Authorized Official Contact | 7185892440 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1065 Southern Boulevard Bronx NY 10452-2417 Ph: (718) 589-2440 | 890 Hunts Point Ave Bronx NY 10474-5402 Ph: (718) 589-2440 |
NPI Number | 1982758066 |
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Provider Enumeration Date | 01/23/2007 |
Last Update Date | 03/17/2011 |
Medicare PECOS PAC ID | 3173517281 |
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Medicare Enrollment ID | O20100304000094 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982758066 | NPI | - | NPPES |
00244977 | Medicaid | NY | |
02994952-00244977 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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