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Specialty details in registry · Bronx, NY

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At a glance

750 Grand Concourse, Bronx, NY 10451-3106

NPPES record updated May 24, 2010. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

750 Grand Concourse 5B
Bronx, NY 10451-3106
Professional details: NPI, taxonomy & registry record
NPI1154640670
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
385H00000X
Enumeration date
May 24, 2010
Record updated
May 24, 2010
More registry details
Provider type
Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

385H00000X · Primary

License reported: 297810-1 NY

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

750 Grand Concourse
5B
Bronx, NY 10451-3106
Phone
(646) 401-6027
Fax
(646) 401-6027
Mailing address
750 GRAND CONCOURSE
5B
BRONX, NY 104513106
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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