| Wellcare Of Bx Medical Pc | |
|
2336 Grand Concourse Bronx NY 10458-6903 | |
| (718) 220-0439 | |
| (718) 933-2914 |
| Full Name | Wellcare Of Bx Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2336 Grand Concourse, Bronx, New York |
| Authorized Official Name and Position | Svetlana Khandros (OWNER) |
| Authorized Official Contact | 7182200439 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellcare Of Bx Medical Pc 2336 Grand Concourse Bronx NY 10458-6903 Ph: (718) 220-0439 | Wellcare Of Bx Medical Pc 2336 Grand Concourse Bronx NY 10458-6903 Ph: (718) 220-0439 |
| NPI Number | 1851848618 |
|---|---|
| Provider Enumeration Date | 09/08/2016 |
| Last Update Date | 09/08/2016 |
| Medicare PECOS PAC ID | 5890040166 |
|---|---|
| Medicare Enrollment ID | O20180611001867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851848618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 228243 (New York) | Primary |
| Provider Name | Charles J Demarco |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1285634576 PECOS PAC ID: 4183525165 Enrollment ID: I20040311001285 |
| Provider Name | Svetlana Khandros |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871578872 PECOS PAC ID: 0345132080 Enrollment ID: I20040326000961 |
| Provider Name | Elaine R Williams |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1710959945 PECOS PAC ID: 4082606561 Enrollment ID: I20040402000629 |
| Provider Name | Lyudmila Poretskaya |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1558386409 PECOS PAC ID: 7315938008 Enrollment ID: I20040520001582 |
| Provider Name | Shan Nagendra |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164533659 PECOS PAC ID: 2062467442 Enrollment ID: I20050526000575 |
| Provider Name | Billy Ford |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1871524538 PECOS PAC ID: 4486675063 Enrollment ID: I20051210000083 |
| Provider Name | Elizabeth Ann Kulesza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043236466 PECOS PAC ID: 3274711932 Enrollment ID: I20110628000309 |
| Provider Name | Pramod Sanghi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1285845370 PECOS PAC ID: 0547354003 Enrollment ID: I20151005002185 |
| Provider Name | Bukky O Otufale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659682920 PECOS PAC ID: 1658789508 Enrollment ID: I20210414002296 |
| Provider Name | Abimbola Otufale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508464397 PECOS PAC ID: 8426451279 Enrollment ID: I20210730001918 |
| Provider Name | Ebony Anna Edouard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114482452 PECOS PAC ID: 8729452081 Enrollment ID: I20230328001751 |
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