Organization
BRONX UNITED IPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BIENVENIDO FAJARDO M.D. (CEO)
(646) 417-0500
Entity
Organization
Contact information
Practice address
140 WADSWORTH AVE APT 4, NEW YORK, NY 10033-4817
(646) 417-0500
Mailing address
140 WADSWORTH AVE APT 4, NEW YORK, NY 10033-4817
(646) 417-0500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NY
207QA0505X
Adult Medicine Physician
—
NY
207R00000X
Internal Medicine Physician
Primary
—
NY
207RN0300X
Nephrology Physician
—
NY
207RP1001X
Pulmonary Disease Physician
—
NY
208000000X
Pediatrics Physician
—
NY
208D00000X
General Practice Physician
—
NY
Other
Enumeration date
08/19/2013
Last updated
07/21/2022
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