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NPI Code Detail

MEDICARE: DOWNTOWN BRONX MEDICAL ASSOCIATES P.C.

MEDICARE: DOWNTOWN BRONX MEDICAL ASSOCIATES 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
1363AS0400XSurgical Physician Assistant006007NY

General Provider Information

NPI Number : 1790833028
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOWNTOWN BRONX MEDICAL ASSOCIATES P.C.
Provider Business Mailing Address
First Line : 3465 ICHABOD CT
Second Line :
City : YORKTOWN HEIGHTS
State : NY
Zip : 10598-2113
Country : US
Telephone Number : 917-841-0102
Fax Number :
Provider Business Practice Location Address
First Line : 506 MALCOLM X BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10037-1802
Country : US
Telephone Number : 212-939-1649
Fax Number :
Authorized Official
Title or Position : EXECUTIVE ADMINISTRATOR
Name : MR. PETER I. GORDON
Credential :
Telephone Number : 718-579-6017
Provider Enumeration Date : 01/05/2007
Last Update Date : 08/19/2008

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