Healthcare Provider Details

I. General information

NPI: 1083467419
Provider Name (Legal Business Name): JMRN CONSULTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 RIVERDALE AVE
BRONX NY
10463-1829
US

IV. Provider business mailing address

5450 NETHERLAND AVE APT E21
BRONX NY
10471-2431
US

V. Phone/Fax

Practice location:
  • Phone: 917-589-7149
  • Fax: 914-219-0955
Mailing address:
  • Phone: 917-589-7149
  • Fax: 914-219-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA BERNSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 917-589-7149