Healthcare Provider Details

I. General information

NPI: 1235762899
Provider Name (Legal Business Name): 121 MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 HENRY HUDSON PKWY APT 2A
BRONX NY
10463-4714
US

IV. Provider business mailing address

2711 HENRY HUDSON PKWY APT 2A
BRONX NY
10463-4714
US

V. Phone/Fax

Practice location:
  • Phone: 212-567-4931
  • Fax:
Mailing address:
  • Phone: 212-567-4931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANIL CRUZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 212-567-4931