| Bronxcare Crotona Park Family Practice | |
|
1591 Fulton Avenue Bronx NY 10457 | |
| (718) 901-8600 | |
| (718) 293-1475 |
| Full Name | Bronxcare Crotona Park Family Practice |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1591 Fulton Avenue, Bronx, New York |
| Authorized Official Name and Position | Victor G Demarco (SENIOR VP-CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7189018600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bronxcare Crotona Park Family Practice 1276 Fulton Ave Bronx NY 10456-3402 Ph: (718) 901-8600 | Bronxcare Crotona Park Family Practice 1591 Fulton Avenue Bronx NY 10457 Ph: (718) 901-8600 |
| NPI Number | 1043518467 |
|---|---|
| Provider Enumeration Date | 03/09/2011 |
| Last Update Date | 06/28/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043518467 | NPI | - | NPPES |
| W0437 | Other | NY | BLUE CROSS |
| 03410597 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 7000212R (New York) | Primary |
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