Healthcare Provider Details

I. General information

NPI: 1851717219
Provider Name (Legal Business Name): BRONXCARE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 GRAND CONCOURSE SUITE 2F
BRONX NY
10457
US

IV. Provider business mailing address

1770 GRAND CONCOURSE SUITE 2F
BRONX NY
10457-5524
US

V. Phone/Fax

Practice location:
  • Phone: 718-901-8158
  • Fax:
Mailing address:
  • Phone: 718-901-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL E GATES
Title or Position: CHAIRMAN
Credential: DDS, MBA
Phone: 718-901-8410