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Organization
MEDALLIANCE MEDICAL HEALTH SERVICES
Active
Organization
MEDALLIANCE MEDICAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARISOL BRAVO (ADMIN ASSISTANT/ CREDENTIALING)
(718) 933-1900
Entity
Organization
Contact information
Practice address
5041 BROADWAY, NEW YORK, NY 10034-1131
(646) 869-2144
(646) 869-4955
Mailing address
625 E FORDHAM RD, BRONX, NY 10458-5049
(718) 933-1900
(718) 563-4039
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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