MEDICARE: BRONX COMMUNITY MEDICINE INTEGRATED CARE 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
1	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1881540094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX COMMUNITY MEDICINE INTEGRATED CARE PLLC

Provider Business Mailing Address
First Line	:	2700 GRAND CONCOURSE # 1A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4918
Country	:	US
Telephone Number	:	718-708-4040
Fax Number	:	718-708-6040

Provider Business Practice Location Address
First Line	:	2700 GRAND CONCOURSE # 1A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-4918
Country	:	US
Telephone Number	:	718-708-4040
Fax Number	:	718-708-6040

Authorized Official
Title or Position	:	OWNER
Name	:	YOHANNA OLIVO MERCEDES
Credential	:	MD
Telephone Number	:	718-708-4040

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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