Provider Demographics
NPI:1114232311
Name:MEDALLIANCE MEDICAL HEALTH SERVICES
Entity type:Organization
Organization Name:MEDALLIANCE MEDICAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:718-933-1900
Mailing Address - Street 1:518 E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2812
Mailing Address - Country:US
Mailing Address - Phone:718-292-6110
Mailing Address - Fax:718-292-6111
Practice Address - Street 1:625 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5049
Practice Address - Country:US
Practice Address - Phone:718-933-1900
Practice Address - Fax:718-563-4039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDALLIANCE MEDICAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000267R261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty