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General NPI Number Information
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NPI Number | 1093352874
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Entity Type | Organization
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Legal Business Name | BRONX MEDICAL HEALTH PROVIDER PC
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Dates
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Enumeration Date | 11/29/2019
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Last Update Date | 11/29/2019
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Provider Practice Location Address
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Address Line | 8027 135TH ST
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City | JAMAICA
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State | NY
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Zip | 11435-1029
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Country | US
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Telephone | 718-544-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 55 E 190TH ST
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City | BRONX
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State | NY
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Zip | 10468-4574
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OPEOLUWA ELEYINAFE
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Credential |
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Telephone | 347-634-2447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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