Healthcare Provider Details

I. General information

NPI: 1639276967
Provider Name (Legal Business Name): J.J.PETERS VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

J.J.PETERS V. A. M. C. 130 KINGSBRIDGE ROAD
BRONX NY
10468
US

IV. Provider business mailing address

171 LAWRENCE AVE
EASTCHESTER NY
10709-5417
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax:
Mailing address:
  • Phone: 914-482-1834
  • Fax: 718-741-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number202704
License Number StateNY

VIII. Authorized Official

Name: DR. SARITA PATEL
Title or Position: PALLIATIVE CARE FELLOW
Credential: M.D.
Phone: 718-584-9000