Provider Demographics
NPI:1952705220
Name:BRONX DOCTOR OFFICE P.C.
Entity Type:Organization
Organization Name:BRONX DOCTOR OFFICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SCHOENWEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-734-5714
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-960-4311
Mailing Address - Fax:347-657-3341
Practice Address - Street 1:1757 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-960-4311
Practice Address - Fax:347-657-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04025430Medicaid