Provider Demographics
NPI:1669642211
Name:BRONX AIDS SERVICES, INC
Entity Type:Organization
Organization Name:BRONX AIDS SERVICES, INC
Other - Org Name:BOOMHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CPO
Authorized Official - Prefix:
Authorized Official - First Name:NUNZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-295-5605
Mailing Address - Street 1:540 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5015
Mailing Address - Country:US
Mailing Address - Phone:718-295-5605
Mailing Address - Fax:718-733-3429
Practice Address - Street 1:540 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5015
Practice Address - Country:US
Practice Address - Phone:718-295-5605
Practice Address - Fax:718-733-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01243521Medicaid