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Organization
IMPACT MEDICAL PC
Active
Organization
IMPACT MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEAN ANTHONY BASULTO MD (SOLO OWNER)
(718) 665-2900
Entity
Organization
Contact information
Practice address
552 E 180TH ST, BRONX, NY 10457-3304
(718) 933-4445
(718) 933-4444
Mailing address
552 E 180TH ST, BRONX, NY 10457-3304
(718) 933-4445
(718) 933-4444
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
205919
NY
Other
Enumeration date
03/07/2013
Last updated
03/07/2013
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