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999 Freeman St Bronx NY 10459-2153 | |
| (718) 589-2440 | |
| (718) 991-4516 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 999 Freeman St, Bronx, New York |
| Authorized Official Name and Position | Samuel Deleon (VP/CMO MEDICAL AFFAIRS) |
| Authorized Official Contact | 7185892440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1065 Southern Blvd Bronx NY 10459-2417 Ph: (718) 589-2440 | 999 Freeman St Bronx NY 10459-2153 Ph: (718) 589-2440 |
| NPI Number | 1467750760 |
|---|---|
| Provider Enumeration Date | 03/10/2011 |
| Last Update Date | 03/10/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467750760 | NPI | - | NPPES |
| 02994952 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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