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250 Grand Concourse Bronx NY 10451-5430 | |
| (718) 292-2240 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 250 Grand Concourse, Bronx, New York |
| Authorized Official Name and Position | Charles Madray (VICE PRESIDENT OF HEALTH SERVICES &) |
| Authorized Official Contact | 7182062000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13802 Queens Blvd Briarwood NY 11435-2642 Ph: () - | 250 Grand Concourse Bronx NY 10451-5430 Ph: (718) 292-2240 |
| NPI Number | 1154795235 |
|---|---|
| Provider Enumeration Date | 11/30/2015 |
| Last Update Date | 04/15/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154795235 | NPI | - | NPPES |
| 000245309 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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