Provider Demographics
NPI:1356493639
Name:S.R.BELVIS DIAG.&TREATMENT CENTER
Entity type:Organization
Organization Name:S.R.BELVIS DIAG.&TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-579-4021
Mailing Address - Street 1:549 E 142ND STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:549 E 142ND STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454
Practice Address - Country:US
Practice Address - Phone:718-579-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01204773Medicaid