1437360997 NPI number — NORTH BRONX FACULTY PRACTICE

Table of content: (NPI 1437360997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437360997 NPI number — NORTH BRONX FACULTY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BRONX FACULTY PRACTICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437360997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 PELHAM PKWY S
Provider Second Line Business Mailing Address:
RM BS 35
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10461-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-918-7313
Provider Business Mailing Address Fax Number:
718-975-5685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 PELHAM PKWY S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10461-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-338-5300
Provider Business Practice Location Address Fax Number:
516-333-1075
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLUMBERG
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-918-5826

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02239563 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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