Healthcare Provider Details

I. General information

NPI: 1679455083
Provider Name (Legal Business Name): MODERN HEALTHCARE FAMILY HEALTH NP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 ARLINGTON AVE APT 10W
BRONX NY
10471-1413
US

IV. Provider business mailing address

5800 ARLINGTON AVE APT 10W
BRONX NY
10471-1413
US

V. Phone/Fax

Practice location:
  • Phone: 917-405-5490
  • Fax:
Mailing address:
  • Phone: 917-405-5490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GENESIS GRULLON
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 917-405-5490