Organization
GRAND CONCOURSE HEALTH WELLNESS MEDICAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DMITRY ILYEVSKY MD (PRESIDENT)
(718) 220-0439
Entity
Organization
Contact information
Practice address
2336 GRAND CONCOURSE, BRONX, NY 10458-6903
(718) 220-0439
(718) 220-0489
Mailing address
2336 GRAND CONCOURSE, BRONX, NY 10458-6903
(718) 220-0439
(718) 220-0489
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
260048
NY
208000000X
Pediatrics Physician
260048
NY
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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