Organization · NPI-2

334 Grand Concourse Medical PC

Urology · Bronx, NY

NPI number1225699648
StatusActive
Last updated in NPPESJul 6, 2020

Details

NPI
1225699648
Entity type
Organization (NPI-2)
Legal business name
334 Grand Concourse Medical PC
Organization subpart
No
Enumeration date
Jun 26, 2019
Certification date
Jul 6, 2020
Last updated
Jul 6, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208800000X Urology––Yes

Practice location

444 Willis Ave
Bronx, NY 10455-4013

Phone 718-841-7392 · Fax 347-862-2711

Mailing address

444 Willis Ave
Bronx, NY 10455-4013

Phone 718-841-7392 · Fax 347-862-2711

Authorized official

Errol C Mallett
President
7188417392

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