Healthcare Provider Details

I. General information

NPI: 1629491238
Provider Name (Legal Business Name): YONKERS GENERAL MEDICAL PRACTICE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 WARBURTON AVE
YONKERS NY
10701-2723
US

IV. Provider business mailing address

48 WARBURTON AVE
YONKERS NY
10701-2723
US

V. Phone/Fax

Practice location:
  • Phone: 917-837-4210
  • Fax:
Mailing address:
  • Phone: 917-837-4210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number181742
License Number StateNY

VIII. Authorized Official

Name: SERGIO ANTONIO MARTINEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 917-837-4210