| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3144 3rd Ave, Bronx, New York |
| Authorized Official Name and Position | Nicholas Martin (COMPLIANCE ANALYST) |
| Authorized Official Contact | 2122717269 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
356 W 18th St New York NY 10011-4401 Ph: (212) 271-7200 | 3144 3rd Ave Bronx NY 10451-4629 Ph: (212) 271-7200 |
| NPI Number | 1295108025 |
|---|---|
| Provider Enumeration Date | 11/02/2015 |
| Last Update Date | 03/15/2018 |
| Medicare PECOS PAC ID | 1254223217 |
|---|---|
| Medicare Enrollment ID | O20160722002122 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295108025 | NPI | - | NPPES |
| 571052 | Other | MEDICARE | |
| 04626028 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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