Provider Demographics
NPI:1073330247
Name:SOUTH BRONX MEDICAL
Entity type:Organization
Organization Name:SOUTH BRONX MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NEESHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-699-7246
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-0110
Mailing Address - Country:US
Mailing Address - Phone:855-699-7246
Mailing Address - Fax:718-766-9763
Practice Address - Street 1:951 BROOK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4209
Practice Address - Country:US
Practice Address - Phone:855-699-7246
Practice Address - Fax:718-766-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty