| Ccn General Medicine Pllc | |
|
1262 Boston Rd Suite 2 Bronx NY 10456-3602 | |
| (718) 569-7929 | |
| (347) 590-5482 |
| Full Name | Ccn General Medicine Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1262 Boston Rd, Bronx, New York |
| Authorized Official Name and Position | Cecilia G Calderon (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7185697929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccn General Medicine Pllc 1262 Boston Rd Suite 2 Bronx NY 10456-3602 Ph: (718) 569-7929 | Ccn General Medicine Pllc 1262 Boston Rd Suite 2 Bronx NY 10456-3602 Ph: (718) 569-7929 |
| NPI Number | 1902120025 |
|---|---|
| Provider Enumeration Date | 03/18/2010 |
| Last Update Date | 07/08/2010 |
| Medicare PECOS PAC ID | 3577699339 |
|---|---|
| Medicare Enrollment ID | O20100331000407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902120025 | NPI | - | NPPES |
| 02932589 | Medicaid | NY | |
| 1427118140 | Other | NY | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 255626 (New York) | Primary |
| Provider Name | Marcia B Pehr |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1265655575 PECOS PAC ID: 4385533918 Enrollment ID: I20040312000198 |
| Provider Name | Hector Perez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851415426 PECOS PAC ID: 0042269573 Enrollment ID: I20050121000425 |
| Provider Name | Melissa M Rodriguez-ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679665301 PECOS PAC ID: 4385747393 Enrollment ID: I20070313000141 |
| Provider Name | Cecilia G Calderon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427118140 PECOS PAC ID: 0143314880 Enrollment ID: I20070926000033 |
| Provider Name | Melida D Knibbs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154518280 PECOS PAC ID: 9335384692 Enrollment ID: I20130315000068 |
| Provider Name | Angelica Echevarria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013463652 PECOS PAC ID: 1951685841 Enrollment ID: I20170221000140 |
| Provider Name | Tariq Mahmood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619386414 PECOS PAC ID: 6204131634 Enrollment ID: I20170321000233 |
| Provider Name | David Lazala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700198512 PECOS PAC ID: 6204102957 Enrollment ID: I20171024002513 |
| Provider Name | Laura Calderon-colon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033656624 PECOS PAC ID: 4082039839 Enrollment ID: I20200827003666 |
| Provider Name | Taisha Cruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013539733 PECOS PAC ID: 7517372717 Enrollment ID: I20210222001702 |
| Provider Name | Diana Munoz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811557846 PECOS PAC ID: 4789090226 Enrollment ID: I20210309001421 |
| Provider Name | Luz Maria Quezada Silva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942795356 PECOS PAC ID: 3779972120 Enrollment ID: I20211105001154 |
| Provider Name | Michelle Melo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598385809 PECOS PAC ID: 9638589617 Enrollment ID: I20240507000476 |
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