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NPI Code Detail

MEDICARE: PERRY AVE FAMILY MEDICAL CENTER INC

MEDICARE: PERRY AVE FAMILY MEDICAL CENTER INC
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
1207KA0200XAllergy Physician
2207R00000XInternal Medicine Physician
3207V00000XObstetrics & Gynecology Physician
4208000000XPediatrics Physician
5207Q00000XFamily 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
22000416OTHERNYGHI
37829562OTHERNYAETNA
4S70F11OTHERNYBLUE CROSS
5041227000012OTHERNYFIDELIS
62478450OTHERNYUNITED HEALTH CARE

General Provider Information

NPI Number : 1619973518
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERRY AVE FAMILY MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 3071 PERRY AVE
Second Line :
City : BRONX
State : NY
Zip : 10467-4111
Country : US
Telephone Number : 718-231-6700
Fax Number : 718-515-5454
Provider Business Practice Location Address
First Line : 3071 PERRY AVE
Second Line :
City : BRONX
State : NY
Zip : 10467-4111
Country : US
Telephone Number : 718-231-6700
Fax Number : 718-515-5454
Authorized Official
Title or Position : OPERATIONS MANAGER
Name : MRS. SHAMA R KHAN
Credential :
Telephone Number : 718-231-6700
Provider Enumeration Date : 06/24/2005
Last Update Date : 07/08/2015

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BRONX, NY
10467-4111
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1194238105 — NEHALBEN G. SAKHARELIYA FNP
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10467-4111
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10467-4111
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Practice Fax:
1962225953 — ESMA RAMAJ
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BRONX, NY
10467-4111
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Directions to “PERRY AVE FAMILY MEDICAL CENTER INC ” Practice Location

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