Organization
CONCOURSE VILLAGE PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN R. MACENAT (PRESIDENT)
(718) 402-4021
Entity
Organization
Contact information
Practice address
769 CONCOURSE VLG W, BRONX, NY 10451-3801
(718) 402-4021
(718) 402-4023
Mailing address
769 CONCOURSE VLG W, BRONX, NY 10451-3801
(718) 402-4021
(718) 402-4023
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
211364
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JM0301AR0
BLUE CROSS/SHIELD
—
Enumeration date
02/25/2008
Last updated
02/25/2008
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