Healthcare Provider Details

I. General information

NPI: 1043379332
Provider Name (Legal Business Name): PROMESA ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WESTCHESTER AVENUE
BRONX NY
10457
US

IV. Provider business mailing address

308 EAST 175TH STREET
BRONX NY
10457
US

V. Phone/Fax

Practice location:
  • Phone: 347-649-3083
  • Fax: 347-649-3090
Mailing address:
  • Phone: 347-649-3083
  • Fax: 347-649-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MILTON DERIENZO
Title or Position: CHIEF FINANCIAL OFFICIER
Credential:
Phone: 347-649-3083