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Organization
CONCOURSE MEDICAL CENTER INC
Active
Organization
CONCOURSE MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANA MATOS CASAC ADVANCED (EXECUTIVE DIRECTOR)
(718) 665-9340
Entity
Organization
Contact information
Practice address
880 MORRIS AVE, BRONX, NY 10451-3412
(718) 665-9340
Mailing address
880 MORRIS AVE, BRONX, NY 10451-3412
(718) 665-9340
(718) 665-2394
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
090111295
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02243034
—
NY
01
—
A300233658
MEDICARE
NY
01
—
A400073294
MEDICARE
NY
Enumeration date
05/22/2007
Last updated
07/09/2021
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