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1400 Pelham Pkwy S Bronx NY 10461-1138 | |
| (718) 918-3677 | |
| (718) 918-7113 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1400 Pelham Pkwy S, Bronx, New York |
| Authorized Official Name and Position | Maxine J. Katz (ASSISTANT VICE PRESIDENT) |
| Authorized Official Contact | 6464583402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
160 Water St Room736 New York NY 10038-4922 Ph: (646) 458-3402 | 1400 Pelham Pkwy S Bronx NY 10461-1138 Ph: (718) 918-3677 |
| NPI Number | 1134248065 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 07/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134248065 | NPI | - | NPPES |
| 01955908 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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