Provider Demographics
NPI:1790995991
Name:QUEENS BRONX MEDICAL P.C
Entity Type:Organization
Organization Name:QUEENS BRONX MEDICAL P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-274-6100
Mailing Address - Street 1:4102 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3420
Mailing Address - Country:US
Mailing Address - Phone:718-274-6100
Mailing Address - Fax:718-665-1746
Practice Address - Street 1:4102 31ST AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3420
Practice Address - Country:US
Practice Address - Phone:718-274-6100
Practice Address - Fax:718-665-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVA0184AK10OtherEMPIRE BLUE CROSS
NY01914447Medicaid
NY06864GOtherGHI MEDICARE CHOICE
NY1000003667OtherAFFINITY HEALTH PLAN
NY2511884OtherGHI
NY06864OtherNY GHI MEDICARE
NY211067C19OtherHEALTHFIRST
NYAV1067OtherATLANTIS
NY1P1158OtherHEALTHNET
NY00006049401OtherFIDELIS
NY171389OtherELDERPLAN
NY211067OtherHIP
NY=========OtherCIGNA
NYVA0184AK10OtherEMPIRE BLUE CROSS
NY1000003667OtherAFFINITY HEALTH PLAN
NY=========OtherAETNA
NY1P1158OtherHEALTHNET
NY=========OtherCIGNA