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General NPI Number Information
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NPI Number | 1518197052
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Entity Type | Organization
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Legal Business Name | TRACY TOWERS MEDICAL P.C.
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 1560 GRAND CONCOURSE SUITE 102
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City | BRONX
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State | NY
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Zip | 10457-8402
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Country | US
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Telephone | 718-733-6369
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Fax | 718-294-4365
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Provider Business Mailing Address
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Address Line | 1560 GRAND CONCOURSE SUITE 102
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City | BRONX
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State | NY
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Zip | 10457-8402
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Country | US
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Telephone | 718-733-6369
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Fax | 718-294-4365
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAULA PATEL
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Credential | M.D.
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Telephone | 71873363669
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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 | 203633
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 203633
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 203633
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 203633
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License Number State | NY
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