Provider Demographics
NPI:1427489715
Name:BRONX PRIMARY CARE
Entity type:Organization
Organization Name:BRONX PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:THAKOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:RANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-584-0555
Mailing Address - Street 1:3184 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1007
Mailing Address - Country:US
Mailing Address - Phone:718-584-0555
Mailing Address - Fax:718-584-8555
Practice Address - Street 1:3184 GRAND CONCOURSE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1007
Practice Address - Country:US
Practice Address - Phone:718-367-0010
Practice Address - Fax:718-584-8555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONX HEART MEDICAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115361-2208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty