1548653132 NPI number — BRONX COMPREHENSIVE HEMATOLOGY-ONCOLOGY, PLLC

Table of content: (NPI 1548653132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548653132 NPI number — BRONX COMPREHENSIVE HEMATOLOGY-ONCOLOGY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRONX COMPREHENSIVE HEMATOLOGY-ONCOLOGY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1548653132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 PARK HILL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YONKERS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10705-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4487 3RD AVE
Provider Second Line Business Practice Location Address:
FOURTH FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-960-6377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FULGER
Authorized Official First Name:
ILMANA
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
914-423-2029

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  243615 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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