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NPI Code Detail

MEDICARE: VAIL HEALTHCARE MEDICAL PLLC

MEDICARE: VAIL HEALTHCARE MEDICAL 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
1207Q00000XFamily Medicine Physician186141NY

General Provider Information

NPI Number : 1487051207
Entity Type Code : Organization
Provider Name (Legal Business Name) : VAIL HEALTHCARE MEDICAL PLLC
Provider Business Mailing Address
First Line : 1070 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-3268
Country : US
Telephone Number : 718-589-4541
Fax Number : 718-893-8511
Provider Business Practice Location Address
First Line : 1070 SOUTHERN BLVD
Second Line :
City : BRONX
State : NY
Zip : 10459-3268
Country : US
Telephone Number : 718-589-4541
Fax Number : 718-893-8511
Authorized Official
Title or Position : PRESIDENT
Name : DR. SAMUEL A DELEON
Credential : MD
Telephone Number : 718-589-4541
Provider Enumeration Date : 11/21/2014
Last Update Date : 04/22/2015

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Directions to “VAIL HEALTHCARE MEDICAL PLLC ” Practice Location

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