Healthcare Provider Details

I. General information

NPI: 1457441487
Provider Name (Legal Business Name): JUAN JOSE PILARTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GRAND CONCOURSE APT 1E
BRONX NY
10452-9122
US

IV. Provider business mailing address

1001 GRAND CONCOURSE APT 1E
BRONX NY
10452-9122
US

V. Phone/Fax

Practice location:
  • Phone: 718-293-3566
  • Fax:
Mailing address:
  • Phone: 718-293-3566
  • Fax: 718-293-3547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number199747
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: