Provider Demographics
NPI:1043237852
Name:BRONX RIVER MEDICAL ASSOCIATES,PC
Entity Type:Organization
Organization Name:BRONX RIVER MEDICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-405-1700
Mailing Address - Street 1:60 E 208TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2702
Mailing Address - Country:US
Mailing Address - Phone:718-405-1700
Mailing Address - Fax:718-405-7231
Practice Address - Street 1:60 E 208TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2702
Practice Address - Country:US
Practice Address - Phone:718-405-1700
Practice Address - Fax:718-405-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01355971Medicaid
NY01355971Medicaid
NY01355971Medicaid