MEDICARE: BRONX WESTCHESTER MEDICAL GROUP

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	174400000X	Specialist	163283	NY

General Provider Information

NPI Number	:	1831304245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX WESTCHESTER MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1521 JARRET PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2606
Country	:	US
Telephone Number	:	718-518-1276
Fax Number	:	718-518-1281

Provider Business Practice Location Address
First Line	:	1521 JARRET PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2606
Country	:	US
Telephone Number	:	718-518-1276
Fax Number	:	718-518-1281

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROBERT LAITMAN
Credential	:	M.D.
Telephone Number	:	718-518-1276

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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