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NPI Code Detail

MEDICARE: BRMC MEDICAL PLLC

MEDICARE: BRMC 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
1174400000XSpecialist214716NY

General Provider Information

NPI Number : 1629358908
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRMC MEDICAL PLLC
Provider Business Mailing Address
First Line : 1262 BOSTON RD
Second Line : 2ND FLOOR
City : BRONX
State : NY
Zip : 10456-3602
Country : US
Telephone Number : 718-617-2500
Fax Number : 718-617-0550
Provider Business Practice Location Address
First Line : 1262 BOSTON RD
Second Line : 2ND FLOOR
City : BRONX
State : NY
Zip : 10456-3602
Country : US
Telephone Number : 718-617-2500
Fax Number : 718-617-0550
Authorized Official
Title or Position : PRESIDENT
Name : DR. JORGE CORNIELLE
Credential : M.D.
Telephone Number : 718-617-2500
Provider Enumeration Date : 08/18/2011
Last Update Date : 08/18/2011

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