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General NPI Number Information
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NPI Number | 1497981328
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Entity Type | Organization
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Legal Business Name | THE PAC PROGRAM OF THE BRONX
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 1215 STRATFORD AVE
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City | BRONX
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State | NY
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Zip | 10472-2501
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Country | US
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Telephone | 718-328-2605
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Fax | 718-328-2609
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Provider Business Mailing Address
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Address Line | 1215 STRATFORD AVE
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City | BRONX
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State | NY
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Zip | 10472-2501
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Country | US
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Telephone | 718-328-2605
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Fax | 718-328-2609
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Authorized Official
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Title or Position | CFO
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Name | ZEEV BANNETT
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Credential |
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Telephone | 908-705-4902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 100411691
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License Number State | NY
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