MEDICARE: JAMES J. PETER'S, BRONX VETERAN MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2865M2000X	Military General Acute Care Hospital

General Provider Information

NPI Number	:	1053695015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES J. PETER'S, BRONX VETERAN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1840 GRAND CONCOURSE APT 3B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-5506
Country	:	US
Telephone Number	:	646-244-8365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 GRAND CONCOURSE APT 3B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-5506
Country	:	US
Telephone Number	:	646-244-8365
Fax Number	:

Authorized Official
Title or Position	:	RESEARCH COORDINATOR
Name	:	DR. RAJESH ARUN PERSAUD
Credential	:	M.D.
Telephone Number	:	718-584-9000

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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