| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 730 Brook Avenue, Bronx, New York |
| Authorized Official Name and Position | Michael G Dowling (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 9143774668 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Corporate Dr Cmo Provider Iformation Yonkers NY 10701-6807 Ph: () - | 730 Brook Avenue Bronx NY 10455 Ph: (718) 484-1247 |
| NPI Number | 1164776159 |
|---|---|
| Provider Enumeration Date | 10/30/2012 |
| Last Update Date | 10/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164776159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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