Healthcare Provider Details

I. General information

NPI: 1265643001
Provider Name (Legal Business Name): BRONX CARDIOLOGY, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865A WALTON AVE
BRONX NY
10451-2210
US

IV. Provider business mailing address

865A WALTON AVE
BRONX NY
10451-2210
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-9200
  • Fax: 718-292-9205
Mailing address:
  • Phone: 718-292-9200
  • Fax: 718-292-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number147523
License Number StateNY

VIII. Authorized Official

Name: DR. EDWARD J BROWN JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-292-9200