Provider Demographics
NPI:1851603898
Name:BRONX MEDICAL CARE ASSOC., P.C
Entity Type:Organization
Organization Name:BRONX MEDICAL CARE ASSOC., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AS PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:718-518-9200
Mailing Address - Street 1:1217 CASTLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4804
Mailing Address - Country:US
Mailing Address - Phone:718-518-9200
Mailing Address - Fax:866-789-9522
Practice Address - Street 1:1217 CASTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4804
Practice Address - Country:US
Practice Address - Phone:718-518-9200
Practice Address - Fax:866-789-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A64393Medicare UPIN