| |
2021 Grand Concourse Bronx NY 10453-4304 | |
(718) 960-9000 | |
(718) 960-3824 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2021 Grand Concourse, Bronx, New York |
Authorized Official Name and Position | Mary Hartnett (CFO) |
Authorized Official Contact | 7189609000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2021 Grand Concourse Bronx NY 10453-4304 Ph: (718) 960-9000 | 2021 Grand Concourse Bronx NY 10453-4304 Ph: (718) 960-9000 |
NPI Number | 1285860544 |
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Provider Enumeration Date | 06/01/2009 |
Last Update Date | 07/10/2009 |
Medicare PECOS PAC ID | 4486545266 |
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Medicare Enrollment ID | O20080623000249 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285860544 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (New York) | Primary |
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