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871 Prospect Ave Bronx NY 10459-3913 | |
| (718) 920-4321 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 871 Prospect Ave, Bronx, New York |
| Authorized Official Name and Position | Joel Perlman (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7189207602 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
111 E 210th St Bronx NY 10467-2401 Ph: (718) 920-5318 | 871 Prospect Ave Bronx NY 10459-3913 Ph: (718) 920-4321 |
| NPI Number | 1891869541 |
|---|---|
| Provider Enumeration Date | 11/17/2006 |
| Last Update Date | 07/11/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891869541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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