Organization
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Active
Parent organization
BRONXCARE DR. MARTIN LUTHER KING JR HEALTH CENTER INC
Other names
BronxCare Dental Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
BRONXCARE DR. MARTIN LUTHER KING JR HEALTH CENTER INC
Authorized official
MR. VICTOR G DEMARCO CPA (SENIOR VP-CHIEF FINANCIAL OFFICER)
(718) 901-8600
Entity
Organization
Contact information
Practice address
1775 GRAND CONCOURSE, BRONX, NY 10453
(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
—
03410919
—
NY
01
—
W0437
BLUE CROSS
NY
Enumeration date
03/09/2011
Last updated
06/28/2018
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