# MEDALLIANCE MEDICAL HEALTH SERVICES

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

## Provider details

- **NPI number:** 1982243887
- **Authorized official:** MARISOL BRAVO (ADMIN ASSISTANT/ CREDENTIALING)
- **Authorized official phone:** (718) 933-1900

## Contact information

- **Practice address:** 5041 BROADWAY, NEW YORK, NY 10034-1131
- **Practice address phone:** (646) 869-2144
- **Practice address fax:** (646) 869-4955
- **Mailing address:** 625 E FORDHAM RD, BRONX, NY 10458-5049
- **Mailing address phone:** (718) 933-1900
- **Mailing address fax:** (718) 563-4039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/26/2019
- **Last updated:** 12/26/2019