Healthcare Provider Details

I. General information

NPI: 1871994228
Provider Name (Legal Business Name): ELMER ARTEAGA MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 GRAND CONCOURSE APT 2M
BRONX NY
10468-1226
US

IV. Provider business mailing address

3201 GRAND CONCOURSE APT 2M
BRONX NY
10468-1226
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-4442
  • Fax: 718-220-4546
Mailing address:
  • Phone: 718-220-4442
  • Fax: 718-220-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192323
License Number StateNY

VIII. Authorized Official

Name: DR. ELMER C ARTEAGA
Title or Position: DOCTOR
Credential: MD
Phone: 71822044442