| Basics | |
|
915 Westchester Ave Bronx NY 10459 | |
| (646) 224-9300 | |
| Not Available |
| Full Name | Basics |
|---|---|
| Speciality | Clinic/Center |
| Location | 915 Westchester Ave, Bronx, New York |
| Authorized Official Name and Position | Vicky Gatell (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7189607629 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Basics 311 E 175th St Bronx NY 10457-5859 Ph: (718) 960-7568 | Basics 915 Westchester Ave Bronx NY 10459 Ph: (646) 224-9300 |
| NPI Number | 1568492718 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 09/23/2022 |
| Certification Date | 09/23/2022 |
| Medicare PECOS PAC ID | 7810095890 |
|---|---|
| Medicare Enrollment ID | O20070614000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568492718 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 7000265R (New York) | Primary |
| Provider Name | David Collymore |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023000353 PECOS PAC ID: 4981696283 Enrollment ID: I20040330000518 |
| Provider Name | Shannon R Dingle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982157137 PECOS PAC ID: 3274873013 Enrollment ID: I20190314000990 |
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