Medalliance Medical Health Services
Clinic/Center, Multi-Specialty in New York, NY. Organization (NPI-2).
NPI number1982243887
StatusActive
Last updated in NPPESDec 26, 2019
Details
- NPI
- 1982243887
- Entity type
- Organization (NPI-2)
- Legal business name
- Medalliance Medical Health Services
- Organization subpart
- No
- Enumeration date
- Dec 26, 2019
- Certification date
- Dec 26, 2019
- Last updated
- Dec 26, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
Practice location
5041 BroadwayNew York, NY 10034-1131
Phone 646-869-2144 · Fax 646-869-4955
Mailing address
625 E Fordham RdBronx, NY 10458-5049
Phone 718-933-1900 · Fax 718-563-4039
Authorized official
Marisol Bravo
Admin Assistant/ Credentialing
7189331900
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