Healthcare Provider Details

I. General information

NPI: 1972649168
Provider Name (Legal Business Name): ARTEMIO CAMACHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E 142ND ST
BRONX NY
10454-2110
US

IV. Provider business mailing address

2245 BARKER AVE APT 1B
BRONX NY
10467-8052
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-1718
  • Fax: 718-579-4009
Mailing address:
  • Phone: 347-275-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number214636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: