MEDICARE: TRI CENTER - BRONX

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	080711466	NY

General Provider Information

NPI Number	:	1528232923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI CENTER - BRONX

Provider Business Mailing Address
First Line	:	2488 GRAND CONCOURSE
Second Line	:	STE 417
City	:	BRONX
State	:	NY
Zip	:	10458-5203
Country	:	US
Telephone Number	:	718-584-7204
Fax Number	:	718-584-8395

Provider Business Practice Location Address
First Line	:	2488 GRAND CONCOURSE
Second Line	:	STE 417
City	:	BRONX
State	:	NY
Zip	:	10458-5203
Country	:	US
Telephone Number	:	718-584-7204
Fax Number	:	718-584-8395

Authorized Official
Title or Position	:	COO
Name	:	MS. DEBORAH DEBORAH MANNERS-GREENE
Credential	:	MSW, CASAC
Telephone Number	:	718-584-7204

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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