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165 E Burnside Ave Bronx NY 10453-4104 | |
| (718) 539-0003 | |
| (718) 569-9054 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 165 E Burnside Ave, Bronx, New York |
| Authorized Official Name and Position | Pedro Espada (PRESIDENT & CEO) |
| Authorized Official Contact | 7185892232 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
731 White Plains Rd Bronx NY 10473-2631 Ph: (718) 589-8324 | 165 E Burnside Ave Bronx NY 10453-4104 Ph: (718) 539-0003 |
| NPI Number | 1821252743 |
|---|---|
| Provider Enumeration Date | 07/10/2008 |
| Last Update Date | 06/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821252743 | NPI | - | NPPES |
| 00665274 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 7000239R (New York) | Primary |
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