Healthcare Provider Details

I. General information

NPI: 1215010988
Provider Name (Legal Business Name): BRONX STATE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WATERS PL
BRONX NY
10461-2723
US

IV. Provider business mailing address

341 S 6TH AVE
MOUNT VERNON NY
10550-4113
US

V. Phone/Fax

Practice location:
  • Phone: 718-862-5409
  • Fax:
Mailing address:
  • Phone: 718-862-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberP46503
License Number StateNY

VIII. Authorized Official

Name: DR. EMMANUEL TOCHUKWU OKEKE
Title or Position: CHILD & ADOLESCENT PSYCHIATRIST
Credential: MD
Phone: 718-862-5409