Provider Demographics
NPI:1942645247
Name:BRONX COMMUNITY MEDICINE, PLLC
Entity Type:Organization
Organization Name:BRONX COMMUNITY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:YOHANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:OLIVO MERCEDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-204-3437
Mailing Address - Street 1:2676 GRAND CONCOURSE
Mailing Address - Street 2:A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4914
Mailing Address - Country:US
Mailing Address - Phone:718-708-4040
Mailing Address - Fax:718-708-6040
Practice Address - Street 1:2676 GRAND CONCOURSE # A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4914
Practice Address - Country:US
Practice Address - Phone:718-708-4040
Practice Address - Fax:718-708-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266860261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ268781YH9B.OtherMEDICARE PTAN
NYA100097539OtherMEDICARE PTAN
NJ0333794Medicaid
FL003250800Medicaid
FL003250800Medicaid