Provider Demographics
NPI:1992889984
Name:DOWNTOWN BRONX MEDICAL ASSOCIATES,P.C.
Entity type:Organization
Organization Name:DOWNTOWN BRONX MEDICAL ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:ANATOLYEVICH
Authorized Official - Last Name:PROKHOROV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-579-6200
Mailing Address - Street 1:2180 HOLLAND AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1739
Mailing Address - Country:US
Mailing Address - Phone:718-892-0432
Mailing Address - Fax:
Practice Address - Street 1:2180 HOLLAND AVE APT 3B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1739
Practice Address - Country:US
Practice Address - Phone:718-892-0432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1366419962Medicare UPIN