Healthcare Provider Details

I. General information

NPI: 1972255446
Provider Name (Legal Business Name): FIRST PRIORITY HEALTH MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 137TH ST APT 6G
BRONX NY
10454-3910
US

IV. Provider business mailing address

2230 TENBROECK AVE
BRONX NY
10469-5414
US

V. Phone/Fax

Practice location:
  • Phone: 917-773-2505
  • Fax: 718-228-5380
Mailing address:
  • Phone: 917-773-2505
  • Fax: 718-228-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. RAUL A ULLOA
Title or Position: PRESIDENT
Credential: MD
Phone: 917-773-2505