Organization · NPI-2

334 Medical PC

Internal Medicine · Bronx, NY

NPI number1982968939
StatusActive
Last updated in NPPESJun 25, 2012

Details

NPI
1982968939
Entity type
Organization (NPI-2)
Legal business name
334 Medical PC
Organization subpart
No
Enumeration date
Jun 25, 2012
Last updated
Jun 25, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine205919NYYes

Practice location

334 Grand Concourse
Bronx, NY 10451-5409

Phone 718-993-0200 · Fax 718-993-0204

Mailing address

334 Grand Concourse
Bronx, NY 10451-5409

Phone 718-993-0200 · Fax 718-993-0204

Authorized official

Dean Basulto
M.D
7189930200

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