| Park South Medical Pllc | |
|
1545 Unionport Rd Park South Medical Bronx NY 10462-7714 | |
| (718) 892-2201 | |
| (718) 828-9663 |
| Full Name | Park South Medical Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1545 Unionport Rd, Bronx, New York |
| Authorized Official Name and Position | Monte Ezratty (OWNER) |
| Authorized Official Contact | 7188922201 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park South Medical Pllc 1545 Unionport Rd Park South Medical Bronx NY 10462-7714 Ph: (718) 892-2201 | Park South Medical Pllc 1545 Unionport Rd Park South Medical Bronx NY 10462-7714 Ph: (718) 892-2201 |
| NPI Number | 1427252626 |
|---|---|
| Provider Enumeration Date | 06/12/2007 |
| Last Update Date | 01/03/2008 |
| Medicare PECOS PAC ID | 6608967898 |
|---|---|
| Medicare Enrollment ID | O20070801000799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427252626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 146894 (New York) | Primary |
| Provider Name | Fran E Cook Bolden |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1710990346 PECOS PAC ID: 2769394857 Enrollment ID: I20031105000778 |
| Provider Name | Marc Rosenblatt |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1952392466 PECOS PAC ID: 0749184612 Enrollment ID: I20040217000623 |
| Provider Name | Michael A Pisacano |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1194792887 PECOS PAC ID: 4789576059 Enrollment ID: I20040330000227 |
| Provider Name | Elena Jones |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1134118771 PECOS PAC ID: 0840288494 Enrollment ID: I20040504000036 |
| Provider Name | Dimitria Papadopoulos |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1689640245 PECOS PAC ID: 5698747707 Enrollment ID: I20040810000363 |
| Provider Name | Monte Ezratty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427009331 PECOS PAC ID: 5890896674 Enrollment ID: I20070724000092 |
| Provider Name | Stephen S Schuster |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1871683656 PECOS PAC ID: 2769564319 Enrollment ID: I20080205000007 |
| Provider Name | Jonathan S Harris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972510626 PECOS PAC ID: 8022193242 Enrollment ID: I20080312000580 |
| Provider Name | Nikola Ragusa |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1568625192 PECOS PAC ID: 1153506753 Enrollment ID: I20110426000129 |
| Provider Name | Tatyana Groysman |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1346477445 PECOS PAC ID: 5496992968 Enrollment ID: I20160714002194 |
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