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General NPI Number Information
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NPI Number | 1053526509
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Entity Type | Organization
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Legal Business Name | BRONX PARK REHABILITATION & SPORTS MEDICINE PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 2016 BRONXDALE AVE SUITE 101
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City | BRONX
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State | NY
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Zip | 10462-3388
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Country | US
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Telephone | 718-918-9702
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Fax | 845-942-8623
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Provider Business Mailing Address
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Address Line | 2016 BRONXDALE AVE SUITE 101
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City | BRONX
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State | NY
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Zip | 10462-3388
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Country | US
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Telephone | 718-918-9702
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Fax | 845-942-8623
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Authorized Official
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Title or Position | SUPERVISOR
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Name | DR. SUDHA AKKAPEDDI
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Credential | M.D.
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Telephone | 718-430-7605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 205629
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License Number State | NY
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