Healthcare Provider Details

I. General information

NPI: 1669729117
Provider Name (Legal Business Name): BRONXCARE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457
US

IV. Provider business mailing address

1276 FULTON AVE ROOM 208
BRONX NY
10456-3402
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8918
  • Fax:
Mailing address:
  • Phone: 718-901-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VICTOR GEORGE DEMARCO
Title or Position: CFO/SVP
Credential:
Phone: 718-901-8600