Healthcare Provider Details

I. General information

NPI: 1104861541
Provider Name (Legal Business Name): BRONXCARE SPECIAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 FULTON AVE 6TH FLOOR
BRONX NY
10456
US

IV. Provider business mailing address

1265 FULTON AVE
BRONX NY
10456-3401
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-7006
  • Fax: 718-579-7401
Mailing address:
  • Phone: 718-579-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number025609
License Number StateNY

VIII. Authorized Official

Name: VICTOR GEORGE DEMARCO
Title or Position: CFO
Credential:
Phone: 718-901-8600