Healthcare Provider Details

I. General information

NPI: 1497908826
Provider Name (Legal Business Name): BRONX PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2869 GRAND CONCOURSE STE 1
BRONX NY
10468-1966
US

IV. Provider business mailing address

2869 GRAND CONCOURSE AVE. STE. 1
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 718-220-6272
  • Fax: 718-220-6270
Mailing address:
  • Phone: 718-220-6272
  • Fax: 718-220-6270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number212539-1
License Number StateNY

VIII. Authorized Official

Name: ANGEL L AQUINO
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-220-6272