| Mace Avenue Medical Pc | |
|
2460 Mickle Ave Bronx NY 10469-6240 | |
| (718) 652-4647 | |
| Not Available |
| Full Name | Mace Avenue Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2460 Mickle Ave, Bronx, New York |
| Authorized Official Name and Position | Robert D Pintauro (OWNER) |
| Authorized Official Contact | 7186524647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mace Avenue Medical Pc 2460 Mickle Ave Bronx NY 10469-6240 Ph: (718) 652-4647 | Mace Avenue Medical Pc 2460 Mickle Ave Bronx NY 10469-6240 Ph: (718) 652-4647 |
| NPI Number | 1669607255 |
|---|---|
| Provider Enumeration Date | 05/26/2009 |
| Last Update Date | 05/26/2009 |
| Medicare PECOS PAC ID | 5991840423 |
|---|---|
| Medicare Enrollment ID | O20100310000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669607255 | NPI | - | NPPES |
| 01890904 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 160692 (New York) | Primary |
| Provider Name | Robert D Pintauro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942393343 PECOS PAC ID: 4284823311 Enrollment ID: I20110105000730 |
| Provider Name | Kellyann Patricia Pintauro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528688561 PECOS PAC ID: 7810345758 Enrollment ID: I20231202000244 |
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