Organization
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR G DEMARCO CPA (SENIOR VP-CHIEF FINANCIAL OFFICER)
(718) 901-8600
Entity
Organization
Contact information
Practice address
1265 FRANKLIN AVE, BRONX, NY 10456
(718) 901-8600
(718) 293-1475
Mailing address
1276 FULTON AVE, BRONX, NY 10456-3402
(718) 901-8600
(718) 293-1475
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
7000212R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244573
—
NY
01
—
W0437
BLUE CROSS
NY
Enumeration date
10/19/2006
Last updated
05/31/2018
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