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1309 Fulton Avenue Nycdohmh Morrisania Dhc Bronx NY 10456-2403 | |
| (347) 396-7959 | |
| (718) 992-2889 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Public Health, State Or Local |
| Location | 1309 Fulton Avenue, Bronx, New York |
| Authorized Official Name and Position | Janet Ellis (DIRECTOR OF PATIENT BILING) |
| Authorized Official Contact | 3473966299 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4209 28th St # Cn-48 Long Island City NY 11101-4130 Ph: (347) 396-6299 | 1309 Fulton Avenue Nycdohmh Morrisania Dhc Bronx NY 10456-2403 Ph: (347) 396-7959 |
| NPI Number | 1811925605 |
|---|---|
| Provider Enumeration Date | 06/29/2006 |
| Last Update Date | 01/27/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811925605 | NPI | - | NPPES |
| 00247627 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0905X | Clinic/center - Public Health, State Or Local | (* (Not Available)) | Primary |
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