1957 Bronx Medical P.c.

NPI 1396008801 - Specialist - 174400000X

NPI Details
NPI 1396008801
Enumeration Date 06/19/2012
Last Updated 06/19/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name ILYA ILYA
Position DIRECTOR
Phone (917) 842-2854
Fax
Practice Location
9924 64TH AVE
REGO PARK NY, 11374-2645, US
Phone (917) 842-2854
Fax
Business Location
9924 64TH AVE
REGO PARK NY, 11374-2645, US
Phone
Fax
Toxanomy
Taxonomy Code 174400000X
License State New York
License Number 221943
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According to our database, 1957 Bronx Medical P.c. NPI is 1396008801, taxonomy code is 174400000X and license number is 221943, license state is located at New York. 1957 Bronx Medical P.c. physically located at 9924 64th Ave, Rego Park NY, 11374-2645. NPI Number 1033115704 has the healthcare provider type.

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1396008801 NPI number is provided on an as is basis without warranty of any kind. 1396008801 is maintained by the National Plan & Provider Enumeration System. The contents of 1957 Bronx Medical P.c. are for informational purposes only.