Provider Demographics
NPI:1093352874
Name:BRONX MEDICAL HEALTH PROVIDER PC
Entity Type:Organization
Organization Name:BRONX MEDICAL HEALTH PROVIDER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OPEOLUWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEYINAFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-634-2447
Mailing Address - Street 1:55 E 190TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8027 135TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1029
Practice Address - Country:US
Practice Address - Phone:718-544-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty