| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1 Fordham Plz, Bronx, New York |
| Authorized Official Name and Position | Mary Hartnett (CFO) |
| Authorized Official Contact | 7189609465 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
260 E 188th St Bronx NY 10458-5302 Ph: (718) 960-9465 | 1 Fordham Plz Bronx NY 10458-5871 Ph: (718) 960-9465 |
| NPI Number | 1114153327 |
|---|---|
| Provider Enumeration Date | 06/02/2009 |
| Last Update Date | 09/15/2010 |
| Medicare PECOS PAC ID | 4486545266 |
|---|---|
| Medicare Enrollment ID | O20080623000270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114153327 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New York) | Primary |
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