Organization
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Active
Parent organization
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Other names
Bronx Care Tiffany Med&Ped Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Authorized official
MR. VICTOR G DEMARCO CPA (SENIOR VP-CHIEF FINANCIAL OFFICER)
(718) 901-8600
Entity
Organization
Contact information
Practice address
853 TIFFANY STREET, BRONX, NY 10459
(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
—
03410579
—
NY
01
—
W0437
BLUE CROSS
NY
Enumeration date
03/09/2011
Last updated
05/31/2018
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