Provider Demographics
NPI:1669679478
Name:BRONX INTERNAL MEDICINE
Entity Type:Organization
Organization Name:BRONX INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-562-2481
Mailing Address - Street 1:2385 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8184
Mailing Address - Country:US
Mailing Address - Phone:718-562-2481
Mailing Address - Fax:718-562-2482
Practice Address - Street 1:183RD ST AT 3RD AVE
Practice Address - Street 2:ST BARNABAS HOSIPTAL 7 FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-6205
Practice Address - Fax:718-960-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210261284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG93253Medicare UPIN