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Organization
PERRY AVE FAMILY MEDICAL CENTER INC
Active
Organization
PERRY AVE FAMILY MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHAMA R KHAN (OPERATIONS MANAGER)
(718) 231-6700
Entity
Organization
Contact information
Practice address
3071 PERRY AVE, BRONX, NY 10467-4111
(718) 231-6700
(718) 515-5454
Mailing address
3071 PERRY AVE, BRONX, NY 10467-4111
(718) 231-6700
(718) 515-5454
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02444553
—
NY
01
—
041227000012
FIDELIS
NY
01
—
2000416
GHI
NY
01
—
2478450
UNITED HEALTH CARE
NY
01
—
7829562
AETNA
NY
01
—
S70F11
BLUE CROSS
NY
Enumeration date
06/24/2005
Last updated
07/08/2015
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