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779 Melrose Ave Bronx NY 10451-4440 | |
| (718) 716-4400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 779 Melrose Ave, Bronx, New York |
| Authorized Official Name and Position | Pamella Appia (MANAGER, PROVIDER ENROLLMENT & MAN) |
| Authorized Official Contact | 7184831270 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
85 W Burnside Ave Bronx NY 10453-4015 Ph: (718) 483-1270 | 779 Melrose Ave Bronx NY 10451-4440 Ph: (718) 716-4400 |
| NPI Number | 1023563863 |
|---|---|
| Provider Enumeration Date | 08/22/2016 |
| Last Update Date | 04/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023563863 | NPI | - | NPPES |
| 00590390 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 7000236R (New York) | Primary |
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