Healthcare Provider Details

I. General information

NPI: 1356650071
Provider Name (Legal Business Name): BIMC FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 BAINBRIDGE AVE
BRONX NY
10467-1411
US

IV. Provider business mailing address

160 WATER ST 20TH FLOOR
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 718-655-2400
  • Fax:
Mailing address:
  • Phone: 212-299-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH HACKETT
Title or Position: VP
Credential:
Phone: 212-256-3424