MEDICARE: UNIONPORT FOUNDATION, INC.

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1144655689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIONPORT FOUNDATION, INC.

Provider Business Mailing Address
First Line	:	1070 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5310
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	914-530-2178

Provider Business Practice Location Address
First Line	:	1040 HAVEMEYER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-5382
Country	:	US
Telephone Number	:	718-863-6200
Fax Number	:	914-530-2178

Authorized Official
Title or Position	:	CEO
Name	:	MR. KENNETH GELB
Credential	:
Telephone Number	:	718-863-6200

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/03/2013

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Directions to “UNIONPORT FOUNDATION, INC. ” Practice Location

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