MEDICARE: BRONX URGENT CARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center		NY

General Provider Information

NPI Number	:	1093246274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX URGENT CARE, P.C.

Provider Business Mailing Address
First Line	:	3671 BRONXWOOD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-1147
Country	:	US
Telephone Number	:	917-468-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	1733 E 174TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-1801
Country	:	US
Telephone Number	:	718-994-2273
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CHAIM GLICK
Credential	:
Telephone Number	:	718-994-2273

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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