Healthcare Provider Details

I. General information

NPI: 1174715395
Provider Name (Legal Business Name): BRONX MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 GRAND CONCOURSE
BRONX NY
10451-2705
US

IV. Provider business mailing address

100 LINN AVE
YONKERS NY
10705-2503
US

V. Phone/Fax

Practice location:
  • Phone: 718-537-3392
  • Fax:
Mailing address:
  • Phone: 914-751-5900
  • Fax: 914-965-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number153743
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number153743
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number153743
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number153743
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number153743
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number153743
License Number StateNY

VIII. Authorized Official

Name: DR. OKON E UMANA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-537-3392