MEDICARE: BRONX MEDICAL CARE ASSOC., 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	207R00000X	Internal Medicine Physician	161575	NY

General Provider Information

NPI Number	:	1851603898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX MEDICAL CARE ASSOC., P.C

Provider Business Mailing Address
First Line	:	1217 CASTLE HILL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4804
Country	:	US
Telephone Number	:	718-518-9200
Fax Number	:	866-789-9522

Provider Business Practice Location Address
First Line	:	1217 CASTLE HILL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4804
Country	:	US
Telephone Number	:	718-518-9200
Fax Number	:	866-789-9522

Authorized Official
Title or Position	:	AS PRESIDENT
Name	:	DR. LUIS A DIAZ JR.
Credential	:	MD
Telephone Number	:	718-518-9200

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	12/27/2017

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