Healthcare Provider Details

I. General information

NPI: 1053695015
Provider Name (Legal Business Name): JAMES J. PETER'S, BRONX VETERAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 GRAND CONCOURSE APT 3B
BRONX NY
10457-5506
US

IV. Provider business mailing address

1840 GRAND CONCOURSE APT 3B
BRONX NY
10457-5506
US

V. Phone/Fax

Practice location:
  • Phone: 646-244-8365
  • Fax:
Mailing address:
  • Phone: 646-244-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJESH ARUN PERSAUD
Title or Position: RESEARCH COORDINATOR
Credential: M.D.
Phone: 718-584-9000