Provider Demographics
NPI:1568698132
Name:CONCOURSE MEDICAL OFFICE P C
Entity Type:Organization
Organization Name:CONCOURSE MEDICAL OFFICE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJI
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:AYINLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-220-4380
Mailing Address - Street 1:2951 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1431
Mailing Address - Country:US
Mailing Address - Phone:718-220-4380
Mailing Address - Fax:
Practice Address - Street 1:2951 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1431
Practice Address - Country:US
Practice Address - Phone:718-220-4380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty