# BRONX BOROUGH MEDICAL PRACTICE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124590641
- **Authorized official:** MACK LEE SULLIVAN (OWNER)
- **Authorized official phone:** (914) 395-3691

## Contact information

- **Practice address:** 2494 WILLIAMSBRIDGE RD, BRONX, NY 10469-4806
- **Practice address phone:** (914) 395-3691
- **Mailing address:** 369 WHITE PLAINS RD STE B, EASTCHESTER, NY 10709-2805
- **Mailing address phone:** (914) 395-3691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0010X | Sports Medicine (Internal Medicine) Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/21/2018
- **Last updated:** 12/21/2018