MEDICARE: BRONXVILLE MEDICAL ASSOCIATES, PLLC

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1659539476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONXVILLE MEDICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	559 GRAMATAN AVE
Second Line	:	STE 210
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-2155
Country	:	US
Telephone Number	:	914-668-7333
Fax Number	:	914-668-7410

Provider Business Practice Location Address
First Line	:	559 GRAMATAN AVE
Second Line	:	STE 210
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-2155
Country	:	US
Telephone Number	:	914-668-7333
Fax Number	:	914-668-7410

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. MICHAEL CONTILLO
Credential	:
Telephone Number	:	914-668-7333

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	11/06/2009

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