| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1135 Allerton Ave, Bronx, New York |
| Authorized Official Name and Position | Thomas Omotola Teyibo (DIRECTOR) |
| Authorized Official Contact | 3474272953 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1135 Allerton Ave Bronx NY 10469-5316 Ph: (347) 427-2953 | 1135 Allerton Ave Bronx NY 10469 Ph: (347) 427-2953 |
| NPI Number | 1437210119 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 06/29/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437210119 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 125979 (New York) | Primary |
| 261Q00000X | Clinic/center | 215979 (New York) | Secondary |
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