| X 158 | |
|
800 Home St Bronx NY 10456-5443 | |
| (917) 962-9337 | |
| Not Available |
| Full Name | X 158 |
|---|---|
| Speciality | Clinic/Center |
| Location | 800 Home St, Bronx, New York |
| Authorized Official Name and Position | Paloma Hernandez (PRESIDENT AND CEO) |
| Authorized Official Contact | 7185892440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| X 158 1065 Southern Blvd Bronx NY 10459-2417 Ph: (718) 589-2440 | X 158 800 Home St Bronx NY 10456-5443 Ph: (917) 962-9337 |
| NPI Number | 1285055665 |
|---|---|
| Provider Enumeration Date | 01/02/2014 |
| Last Update Date | 01/02/2014 |
| Medicare PECOS PAC ID | 3173517281 |
|---|---|
| Medicare Enrollment ID | O20140207000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285055665 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 02994952 (New York) | Primary |
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