Provider Demographics
NPI:1689225971
Name:BRIDGESPAN MEDICINE
Entity Type:Organization
Organization Name:BRIDGESPAN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:AVVOCATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-698-5544
Mailing Address - Street 1:222 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604
Mailing Address - Country:US
Mailing Address - Phone:914-698-5544
Mailing Address - Fax:914-698-4847
Practice Address - Street 1:222 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604
Practice Address - Country:US
Practice Address - Phone:914-698-5544
Practice Address - Fax:914-698-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty