Provider Demographics
NPI:1750144531
Name:BRIDGE MEDICAL CARE P C
Entity type:Organization
Organization Name:BRIDGE MEDICAL CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:KUNJUMON
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-269-8777
Mailing Address - Street 1:2005 PALMER AVE # 1050
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2437
Mailing Address - Country:US
Mailing Address - Phone:914-269-8777
Mailing Address - Fax:
Practice Address - Street 1:4008 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1118
Practice Address - Country:US
Practice Address - Phone:914-269-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty