Organization
ROYAL MEDICAL CENTER FOR WOMEN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELVIN K JACK MD (PRESIDENT)
(718) 221-5001
Entity
Organization
Contact information
Practice address
3225 FENTON AVE, BRONX, NY 10469-2801
(718) 221-5001
(718) 221-5505
Mailing address
687 LENOX RD, BROOKLYN, NY 11203-2218
(718) 221-5001
(718) 221-5505
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
272090
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02778018
—
NY
Enumeration date
02/02/2016
Last updated
02/02/2016
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