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General NPI Number Information
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NPI Number | 1790833028
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Entity Type | Organization
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Legal Business Name | DOWNTOWN BRONX MEDICAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 506 MALCOLM X BLVD
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City | NEW YORK
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State | NY
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Zip | 10037-1802
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Country | US
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Telephone | 212-939-1649
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Fax |
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Provider Business Mailing Address
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Address Line | 3465 ICHABOD CT
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2113
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Country | US
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Telephone | 917-841-0102
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MR. PETER I. GORDON
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Credential |
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Telephone | 718-579-6017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 006007
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License Number State | NY
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