Organization
BRONX PARK MEDICAL SURGICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN DIRUSSO M.D. (PRESIDENT)
(718) 960-6126
Entity
Organization
Contact information
Practice address
2016 BRONXDALE AVE, SUITE 202, BRONX, NY 10462-3388
(718) 863-8695
(718) 863-5147
Mailing address
2016 BRONXDALE AVE, SUITE 202, BRONX, NY 10462-3388
(718) 863-8695
(718) 863-5147
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W38541
MEDICARE GROUP PROVIDER #
NY
Enumeration date
07/25/2007
Last updated
07/25/2007
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