Provider Demographics
NPI:1174020887
Name:BRONX LEBANON HOSPITAL CENTER
Entity Type:Organization
Organization Name:BRONX LEBANON HOSPITAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL RESIDENCY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-901-8410
Mailing Address - Street 1:11100 S RIVER HEIGHTS DR APT B209
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-6215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1775 GRAND CONCOURSE FL 6
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-8202
Practice Address - Country:US
Practice Address - Phone:718-590-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty