Provider Demographics
NPI:1134372303
Name:BRONX FOOT REHABILITATION ASSOCIATES
Entity type:Organization
Organization Name:BRONX FOOT REHABILITATION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-655-3410
Mailing Address - Street 1:326 E 204TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-4602
Mailing Address - Country:US
Mailing Address - Phone:718-655-3410
Mailing Address - Fax:718-655-3475
Practice Address - Street 1:326 E 204TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4602
Practice Address - Country:US
Practice Address - Phone:718-655-3410
Practice Address - Fax:718-655-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005547213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377219Medicaid
NY02377219Medicaid
NYU75283Medicare UPIN