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
1	363AS0400X	Surgical Physician Assistant	006007	NY

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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