Provider Demographics
NPI:1376978148
Name:SOUTH BRONX CONCERNED CITIZENS, INC.
Entity Type:Organization
Organization Name:SOUTH BRONX CONCERNED CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-620-7131
Mailing Address - Street 1:1019 AVENUE SAINT JOHN
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3601
Mailing Address - Country:US
Mailing Address - Phone:718-620-7131
Mailing Address - Fax:
Practice Address - Street 1:1019 AVENUE SAINT JOHN
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3601
Practice Address - Country:US
Practice Address - Phone:718-620-7131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicaid