MEDICARE: BRONX MEDICAL SERVICES PLLC

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	261QC1500X	Community Health Clinic/Center	153743	NY
2	261QH0100X	Health Service Clinic/Center	153743	NY
3	261QM1300X	Multi-Specialty Clinic/Center	153743	NY
4	261QP2000X	Physical Therapy Clinic/Center	153743	NY
5	261QP2300X	Primary Care Clinic/Center	153743	NY
6	261Q00000X	Clinic/Center	153743	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	90D672	OTHER	NY	BCBS

General Provider Information

NPI Number	:	1174715395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX MEDICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	100 LINN AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10705-2503
Country	:	US
Telephone Number	:	914-751-5900
Fax Number	:	914-965-1974

Provider Business Practice Location Address
First Line	:	930 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-2705
Country	:	US
Telephone Number	:	718-537-3392
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. OKON E UMANA
Credential	:	MD
Telephone Number	:	718-537-3392

Provider Enumeration Date	:	08/11/2007
Last Update Date	:	04/20/2008

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Directions to “BRONX MEDICAL SERVICES PLLC ” Practice Location

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