MEDICARE: CROTONA PARKWAY ASC, LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1922754605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROTONA PARKWAY ASC, LLC

Provider Business Mailing Address
First Line	:	1976 CROTONA PKWY # 2A3B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-1526
Country	:	US
Telephone Number	:	718-307-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1976 CROTONA PKWY # 2A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-1526
Country	:	US
Telephone Number	:	203-917-0793
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. VALENTYNA MINO
Credential	:	RN
Telephone Number	:	203-917-0793

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/02/2023

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