NPI 1245612803

Nyccc

Organisation Preferred Provider Organization Bronx, NY

Practice location

Address: 1000 Waters Pl, Bronx, NY 10461-2701
Phone: (718) 239-3600
Fax: (718) 239-3669
Mailing address: 1000 Waters Place, Bronx, NY 10461

Authorised official

Name: Brenda Grier
Title: Administrative Secretary 1
Phone: (718) 239-3745

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 2084P0804X (NY)

Other Preferred Provider Organization providers in New York →

Registry record

NPI: 1245612803
Entity type: Organization
NPI issued: 19 Jun 2015
Record last updated: 19 Jun 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.