Healthcare Provider Details

I. General information

NPI: 1740115971
Provider Name (Legal Business Name): VAN CORTLANDT MEDICAL OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GRAND CONCOURSE STE 1K
BRONX NY
10458-1263
US

IV. Provider business mailing address

3130 GRAND CONCOURSE STE 1K
BRONX NY
10458-1263
US

V. Phone/Fax

Practice location:
  • Phone: 718-513-3536
  • Fax: 347-591-0201
Mailing address:
  • Phone: 718-513-3536
  • Fax: 347-591-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BAAH ASANTE
Title or Position: MD
Credential:
Phone: 718-513-3536