Healthcare Provider Details

I. General information

NPI: 1245541366
Provider Name (Legal Business Name): BRONX PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MORRIS PARK AVE FORCHEIMER BUILDING, DEPT. NEUROSCIENCE, F113
BRONX NY
10461-1900
US

IV. Provider business mailing address

1500 WATERS PL
BRONX NY
10461-2723
US

V. Phone/Fax

Practice location:
  • Phone: 718-430-3662
  • Fax:
Mailing address:
  • Phone: 718-862-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE SANTANA
Title or Position: PSYCHIATRY PROGRAM COORDINATOR
Credential:
Phone: 718-862-3395