Healthcare Provider Details

I. General information

NPI: 1801943048
Provider Name (Legal Business Name): PROSPERE REMY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 GRAND CONCOURSE APT 1K
BRONX NY
10451-2815
US

IV. Provider business mailing address

860 GRAND CONCOURSE 1K
BRONX NY
10451-2814
US

V. Phone/Fax

Practice location:
  • Phone: 718-585-5060
  • Fax: 718-585-4866
Mailing address:
  • Phone: 718-585-5060
  • Fax: 718-585-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number184493
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: