Healthcare Provider Details

I. General information

NPI: 1174940605
Provider Name (Legal Business Name): CLASON POINT MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805B SOUNDVIEW AVE
BRONX NY
10473-3900
US

IV. Provider business mailing address

805B SOUNDVIEW AVE
BRONX NY
10473-3900
US

V. Phone/Fax

Practice location:
  • Phone: 646-884-4964
  • Fax: 347-338-2792
Mailing address:
  • Phone: 646-884-4964
  • Fax: 347-338-2792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number263664
License Number StateNY

VIII. Authorized Official

Name: MR. ANGEL A DIAZ
Title or Position: OWNER
Credential: M.D.
Phone: 646-884-4964