Organization
MEDALLIANCE MEDICAL HEALTH SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAHRIAR DANESHVAR CASC (CEO)
(718) 933-1900
Entity
Organization
Contact information
Practice address
625 E FORDHAM RD, BRONX, NY 10458-5049
(718) 933-1900
(718) 563-4039
Mailing address
625 E FORDHAM RD, BRONX, NY 10458-5049
(718) 933-1900
(718) 563-4039
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0261903
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02619203
—
NY
Enumeration date
09/14/2005
Last updated
12/30/2014
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