Healthcare Provider Details

I. General information

NPI: 1881741841
Provider Name (Legal Business Name): MORRISANIA NEIGHBORHOOD FAMILY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE
BRONX NY
10452-8001
US

IV. Provider business mailing address

1225 GERARD AVE
BRONX NY
10452-8001
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2772
  • Fax: 718-960-2628
Mailing address:
  • Phone: 718-960-2772
  • Fax: 718-960-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number015477
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number015477
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number015477
License Number StateNY

VIII. Authorized Official

Name: MS. GAIL ROSENBLATT
Title or Position: SR. ASSO. EXECUTIVE DIRECTOR
Credential:
Phone: 718-960-2649