Organization
A.W MEDICAL OFFICE, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAMON MODESTO TALLAJ M.D (PHYSICIAN)
(718) 294-4008
Entity
Organization
Contact information
Practice address
1624 UNIVERSITY AVE., BRONX, NY 10453-6948
(718) 294-4008
(718) 294-9466
Mailing address
571 ACADEMY ST, STE GLE, NEW YORK, NY 10034-5104
(212) 567-0550
(212) 567-6474
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
204704
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
639AH1
BCBS
NY
Enumeration date
01/29/2008
Last updated
05/15/2012
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