Healthcare Provider Details

I. General information

NPI: 1477629376
Provider Name (Legal Business Name): DOWNTOWN BRONX MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

14 STONEY HOLLOW RD
CHAPPAQUA NY
10514-2014
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5800
  • Fax:
Mailing address:
  • Phone: 914-238-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberNY153350
License Number StateNY

VIII. Authorized Official

Name: SHAFI K CHOUDHURY
Title or Position: ATTENDING
Credential: MD
Phone: 718-579-5800