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General NPI Number Information
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NPI Number | 1114232311
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Entity Type | Organization
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Legal Business Name | MEDALLIANCE MEDICAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 625 E FORDHAM RD
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City | BRONX
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State | NY
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Zip | 10458-5049
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Country | US
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Telephone | 718-933-1900
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Fax | 718-563-4039
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Provider Business Mailing Address
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Address Line | 518 E 149TH ST
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City | BRONX
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State | NY
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Zip | 10455-2812
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Country | US
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Telephone | 718-292-6110
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Fax | 718-292-6111
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS GERALDINE ANN MARAJ
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Credential | MBA
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Telephone | 718-933-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 7000267R
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License Number State | NY
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