Healthcare Provider Details

I. General information

NPI: 1831350842
Provider Name (Legal Business Name): BRONX PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9128 84TH ST
WOODHAVEN NY
11421-2929
US

IV. Provider business mailing address

9128 84TH ST
WOODHAVEN NY
11421-2929
US

V. Phone/Fax

Practice location:
  • Phone: 718-296-1819
  • Fax:
Mailing address:
  • Phone: 718-296-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberP47582
License Number StateNY

VIII. Authorized Official

Name: GREGORY SATHANANTHA
Title or Position: DIRECTOR OF PSYCHIATRY
Credential: MD
Phone: 718-860-5081