Provider Demographics
NPI:1497908826
Name:BRONX PEDIATRICS, PC
Entity Type:Organization
Organization Name:BRONX PEDIATRICS, PC
Other - Org Name:BRONX PEDIATRICS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-220-6272
Mailing Address - Street 1:2869 GRAND CONCOURSE AVE.
Mailing Address - Street 2:STE. 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-220-6272
Mailing Address - Fax:718-220-6270
Practice Address - Street 1:2869 GRAND CONCOURSE STE 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1966
Practice Address - Country:US
Practice Address - Phone:718-220-6272
Practice Address - Fax:718-220-6270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212539-12080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02255127Medicaid
NY637X11Medicare PIN