# A.W MEDICAL OFFICE, P.C

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

## Provider details

- **NPI number:** 1235316563
- **Authorized official:** RAMON MODESTO TALLAJ M.D (PHYSICIAN)
- **Authorized official phone:** (718) 294-4008

## Contact information

- **Practice address:** 1624 UNIVERSITY AVE., BRONX, NY 10453-6948
- **Practice address phone:** (718) 294-4008
- **Practice address fax:** (718) 294-9466
- **Mailing address:** 571 ACADEMY ST, STE GLE, NEW YORK, NY 10034-5104
- **Mailing address phone:** (212) 567-0550
- **Mailing address fax:** (212) 567-6474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 204704 | NY | Yes |

## Other

- **Enumeration date:** 01/29/2008
- **Last updated:** 05/15/2012