Healthcare Provider Details

I. General information

NPI: 1689618407
Provider Name (Legal Business Name): DOWNTOWN BRONX MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST STE 8D200
BRONX NY
10451-5504
US

IV. Provider business mailing address

234 E 149TH ST STE 8D200
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 718-576-6200
  • Fax: 718-579-6060
Mailing address:
  • Phone: 718-576-6200
  • Fax: 718-579-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER I GORDON
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 718-579-6200