Healthcare Provider Details

I. General information

NPI: 1528366945
Provider Name (Legal Business Name): MORRISANIA DIAGNOSTIC AND TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE
BRONX NY
10452-8001
US

IV. Provider business mailing address

1225 GERARD AVE
BRONX NY
10452-8001
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2942
  • Fax: 718-960-2948
Mailing address:
  • Phone: 718-960-2942
  • Fax: 718-960-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NW0100X
TaxonomyWomen's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. ALEXANDRA ALBA
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 718-960-2942