| Mosholu Medical Group P.c | |
|
5750 Mosholu Ave Bronx NY 10471-2206 | |
| (914) 519-7402 | |
| (914) 591-9794 |
| Full Name | Mosholu Medical Group P.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 5750 Mosholu Ave, Bronx, New York |
| Authorized Official Name and Position | Theodore Costa Docu (OWNER) |
| Authorized Official Contact | 7186010627 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mosholu Medical Group P.c 5750 Mosholu Ave Bronx NY 10471-2206 Ph: (914) 519-7402 | Mosholu Medical Group P.c 5750 Mosholu Ave Bronx NY 10471-2206 Ph: (914) 519-7402 |
| NPI Number | 1487059515 |
|---|---|
| Provider Enumeration Date | 10/31/2014 |
| Last Update Date | 07/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487059515 | NPI | - | NPPES |
| 01189151 | Medicaid | NY | |
| 0244899 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 182886 (New York) | Primary |
| 207R00000X | Internal Medicine | 245895 (New York) | Secondary |
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