Organization
BRONX COMMUNITY MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOHANNA MARIA OLIVO MERCEDES (MD)
(347) 204-3437
Entity
Organization
Contact information
Practice address
2676 GRAND CONCOURSE # A, BRONX, NY 10458-4914
(718) 708-4040
(718) 708-6040
Mailing address
2676 GRAND CONCOURSE, A, BRONX, NY 10458-4914
(718) 708-4040
(718) 708-6040
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
266860
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003250800
—
FL
05
—
0333794
—
NJ
01
—
268781YH9B.
MEDICARE PTAN
NJ
01
—
A100097539
MEDICARE PTAN
NY
Enumeration date
05/01/2013
Last updated
09/29/2014
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