Organization
MORRISANIA DIAGNOSTIC AND TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELLIE BOMA M.D. (MEDICAL DIRECTOR)
(718) 960-2793
Entity
Organization
Contact information
Practice address
158 E 115TH ST, NEW YORK, NY 10029-2031
(212) 360-5919
(212) 828-0858
Mailing address
158 E 115TH ST, NEW YORK, NY 10029-2031
(212) 360-5919
(212) 828-0858
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
144173
NY
Other
Enumeration date
10/25/2006
Last updated
08/22/2020
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