Organization
PELHAM PKWY MEDICAL OF NEW YORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMI ALMEDA (CREDENTIALING MANAGER)
(224) 318-0118
Entity
Organization
Contact information
Practice address
2157 WHITE PLAINS RD, BRONX, NY 10462-1405
(718) 301-1100
(224) 246-8042
Mailing address
304 WAINWRIGHT DR, NORTHBROOK, IL 60062-1900
(847) 257-1244
(224) 246-8042
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113246
—
IL
Enumeration date
07/12/2017
Last updated
06/04/2020
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