Healthcare Provider Details

I. General information

NPI: 1700311891
Provider Name (Legal Business Name): NYC COMMUNITY MEDICAL CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 WHITE PLAINS RD
BRONX NY
10472-4904
US

IV. Provider business mailing address

1268 WHITE PLAINS RD
BRONX NY
10472-4904
US

V. Phone/Fax

Practice location:
  • Phone: 917-634-9678
  • Fax:
Mailing address:
  • Phone: 917-634-9678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number256970
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number256970
License Number StateNY

VIII. Authorized Official

Name: DR. ATAUL CHOWDHURY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 917-634-9601