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NPI Code Detail

MEDICARE: 1211 WPR MEDICAL SERVICES PC

MEDICARE: 1211 WPR MEDICAL SERVICES PC
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
1207RC0000XCardiovascular Disease Physician0810561NY
2207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437247509
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1211 WPR MEDICAL SERVICES PC
Provider Business Mailing Address
First Line : 1211 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10472-4900
Country : US
Telephone Number : 718-828-6610
Fax Number : 718-829-9132
Provider Business Practice Location Address
First Line : 1211 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10472-4900
Country : US
Telephone Number : 718-082-8066
Fax Number : 718-829-9132
Authorized Official
Title or Position : AM
Name : AMY CAROL POLAN
Credential :
Telephone Number : 718-828-6610
Provider Enumeration Date : 10/11/2006
Last Update Date : 08/30/2021

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