Provider Demographics
NPI:1326191727
Name:BRONX PARK URGENT MEDICAL CARE PC
Entity Type:Organization
Organization Name:BRONX PARK URGENT MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BPUMC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-661-8250
Mailing Address - Street 1:2016 BRONXDALE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3365
Mailing Address - Country:US
Mailing Address - Phone:718-918-9676
Mailing Address - Fax:
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:914-654-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW4L621Medicare ID - Type Unspecified
NYW4L621Medicare PIN