Provider Demographics
NPI:1790093508
Name:JACOBI-HEALTH AND HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:JACOBI-HEALTH AND HOSPITAL CORPORATION
Other - Org Name:HEALTH CENTER AT GUNHILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STAFF NURSE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-918-8892
Mailing Address - Street 1:3023 BRONXWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3603
Mailing Address - Country:US
Mailing Address - Phone:718-515-2011
Mailing Address - Fax:
Practice Address - Street 1:1012 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3720
Practice Address - Country:US
Practice Address - Phone:718-918-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487360-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care