Organization · NPI-2

A.W Medical Office, P.C

Internal Medicine · Bronx, NY

NPI number1235316563
StatusActive
Last updated in NPPESMay 15, 2012

Details

NPI
1235316563
Entity type
Organization (NPI-2)
Legal business name
A.W Medical Office, P.C
Organization subpart
No
Enumeration date
Jan 29, 2008
Last updated
May 15, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine204704NYYes

Practice location

1624 University Ave.
Bronx, NY 10453-6948

Phone 718-294-4008 · Fax 718-294-9466

Mailing address

571 Academy St
Ste Gle
New York, NY 10034-5104

Phone 212-567-0550 · Fax 212-567-6474

Authorized official

Ramon Modesto Tallaj
Physician
7182944008

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