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NPI Code Detail

MEDICARE: MEDALLIANCE MEDICAL HEALTH SERVICES INC

MEDICARE: MEDALLIANCE MEDICAL HEALTH SERVICES INC
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
1261Q00000XClinic/Center0261903NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558356741
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDALLIANCE MEDICAL HEALTH SERVICES INC
Provider Business Mailing Address
First Line : 625 E FORDHAM RD
Second Line :
City : BRONX
State : NY
Zip : 10458-5049
Country : US
Telephone Number : 718-933-1900
Fax Number : 718-563-4039
Provider Business Practice Location Address
First Line : 625 E FORDHAM RD
Second Line :
City : BRONX
State : NY
Zip : 10458-5049
Country : US
Telephone Number : 718-933-1900
Fax Number : 718-563-4039
Authorized Official
Title or Position : CEO
Name : MR. SHAHRIAR DANESHVAR
Credential : CASC
Telephone Number : 718-933-1900
Provider Enumeration Date : 09/14/2005
Last Update Date : 12/30/2014

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Directions to “MEDALLIANCE MEDICAL HEALTH SERVICES INC ” Practice Location

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