Healthcare Provider Details

I. General information

NPI: 1083853360
Provider Name (Legal Business Name): BROADWAY MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S BROADWAY
YONKERS NY
10701-4004
US

IV. Provider business mailing address

PO BOX 740
YONKERS NY
10703-0740
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-7767
  • Fax: 914-376-7106
Mailing address:
  • Phone: 914-376-7767
  • Fax: 914-376-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD KHALIL
Title or Position: OWNER
Credential: MD
Phone: 914-376-7767