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Organization
GRAND CONCOURSE HEALTH WELLNESS MEDICAL, PC
Active
Organization
GRAND CONCOURSE HEALTH WELLNESS MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DMITRY ILYEVSKY MD (PRESIDENT)
(718) 220-0439
Entity
Organization
Contact information
Practice address
2336 GRAND CONCOURSE, BRONX, NY 10458-6903
(718) 220-0439
(718) 220-0489
Mailing address
2336 GRAND CONCOURSE, BRONX, NY 10458-6903
(718) 220-0439
(718) 220-0489
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
260048
NY
208000000X
Pediatrics Physician
260048
NY
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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