Bronx Borough Medical Practice PC
Physical Medicine & Rehabilitation, Pain Medicine in Bronx, NY. Organization (NPI-2).
Details
- NPI
- 1124590641
- Entity type
- Organization (NPI-2)
- Legal business name
- Bronx Borough Medical Practice PC
- Organization subpart
- No
- Enumeration date
- Dec 21, 2018
- Last updated
- Dec 21, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2081P2900X | Physical Medicine & Rehabilitation, Pain Medicine | – | – | Yes |
| 207RS0010X | Internal Medicine, Sports Medicine | – | – |
Practice location
2494 Williamsbridge RdBronx, NY 10469-4806
Phone 914-395-3691
Mailing address
369 White Plains Rd Ste BEastchester, NY 10709-2805
Phone 914-395-3691
Authorized official
Mack Lee Sullivan
Owner
9143953691
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 18 Pain Medicine (Physical Medicine & Rehabilitation) Physician providers in Bronx · All 38,045 providers in Bronx
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