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General NPI Number Information
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NPI Number | 1740063478
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Entity Type | Organization
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Legal Business Name | SOUTH MEDICAL SERVICES NY PC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 563 E TREMONT AVE
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City | BRONX
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State | NY
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Zip | 10457-4655
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Country | US
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Telephone | 646-580-1876
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Fax |
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Provider Business Mailing Address
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Address Line | 563 E TREMONT AVE
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City | BRONX
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State | NY
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Zip | 10457-4655
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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 | JUAN DELACRUZ
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Credential |
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Telephone | 646-580-1876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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