Healthcare Provider Details

I. General information

NPI: 1285632117
Provider Name (Legal Business Name): EAST TREMONT VASCULAR HEALTH CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 E TREMONT AVE
BRONX NY
10461-5700
US

IV. Provider business mailing address

3175 E TREMONT AVE
BRONX NY
10461-5700
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-7135
  • Fax: 718-823-7136
Mailing address:
  • Phone: 718-823-7135
  • Fax: 718-823-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number202857
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number209680
License Number StateNY

VIII. Authorized Official

Name: MR. MAYANK V PATEL
Title or Position: OWNER
Credential:
Phone: 718-823-7135