Organization · NPI-2

866 Medical Group

Anesthesiology, Pain Medicine · Bronx, NY

NPI number1013350933
StatusActive
Last updated in NPPESApr 10, 2013

Details

NPI
1013350933
Entity type
Organization (NPI-2)
Legal business name
866 Medical Group
Organization subpart
No
Enumeration date
Apr 10, 2013
Last updated
Apr 10, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207LP2900X Anesthesiology, Pain Medicine234017NYYes
207QA0505X Family Medicine, Adult Medicine217149NY

Practice location

866 E Tremont Ave
Bronx, NY 10460-4201

Phone 347-515-0123

Mailing address

866 E Tremont Ave
Bronx, NY 10460-4201

Authorized official

Dante A Cubangbang
President
9179309614

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