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691 E 138th St Bronx NY 10454-3307 | |
| (718) 993-8900 | |
| (212) 366-1773 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 691 E 138th St, Bronx, New York |
| Authorized Official Name and Position | Debbian Fletcher Blake (ASSISTANT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2123664459 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
30 E 33rd St New York NY 10016-5337 Ph: (212) 366-4459 | 691 E 138th St Bronx NY 10454-3307 Ph: (718) 993-8900 |
| NPI Number | 1306182076 |
|---|---|
| Provider Enumeration Date | 12/27/2012 |
| Last Update Date | 04/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306182076 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 70000279R (New York) | Primary |
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