Healthcare Provider Details

I. General information

NPI: 1578658860
Provider Name (Legal Business Name): JAMES PETERS VETERAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

IV. Provider business mailing address

130 W KINGSBRIDGE RD
BRONX NY
10468-3904
US

V. Phone/Fax

Practice location:
  • Phone: 718-584-9000
  • Fax: 718-741-4673
Mailing address:
  • Phone: 718-584-9000
  • Fax: 718-741-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MISS SANDRA LISSETTE CASILLAS
Title or Position: SOCIAL WORKER
Credential: M.S.W.
Phone: 718-584-9000