Provider Demographics
NPI:1740422203
Name:UNIVERSITY MEDICAL OFFICE, PLLC
Entity Type:Organization
Organization Name:UNIVERSITY MEDICAL OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:BELLIARD ESTEVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-393-9079
Mailing Address - Street 1:2270 UNIVERSITY AVE
Mailing Address - Street 2:STE. 1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6265
Mailing Address - Country:US
Mailing Address - Phone:646-393-9079
Mailing Address - Fax:646-393-9081
Practice Address - Street 1:2270 UNIVERSITY AVE
Practice Address - Street 2:STE. 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6265
Practice Address - Country:US
Practice Address - Phone:646-393-9079
Practice Address - Fax:646-393-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181919Medicaid
NY250412OtherLICENSE
NJ25MA08476500OtherLICENSE
NY03128530Medicaid
NJ0181919Medicaid
NYA100019388Medicare PIN