Healthcare Provider Details

I. General information

NPI: 1285794024
Provider Name (Legal Business Name): CMORS MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GRAND CONCOURSE SUITE B4
BRONX NY
10458-1213
US

IV. Provider business mailing address

3130 GRAND CONCOURSE SUITE B4
BRONX NY
10458-1213
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-8800
  • Fax: 718-367-4047
Mailing address:
  • Phone: 718-367-8800
  • Fax: 718-367-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210513
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS G OBRIEN II
Title or Position: MEDICAL DIRECTOR
Credential: D.O
Phone: 718-367-8800