MEDICARE: 121 MEDICAL P.C.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1235762899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	121 MEDICAL P.C.

Provider Business Mailing Address
First Line	:	2711 HENRY HUDSON PKWY APT 2A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4714
Country	:	US
Telephone Number	:	212-567-4931
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 HENRY HUDSON PKWY APT 2A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4714
Country	:	US
Telephone Number	:	212-567-4931
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANIL CRUZ
Credential	:
Telephone Number	:	212-567-4931

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	05/29/2026

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