Provider Demographics
NPI:1174554992
Name:BRONX HEART MEDICAL, P.C
Entity type:Organization
Organization Name:BRONX HEART MEDICAL, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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:APT #1D
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:718-584-0793
Practice Address - Street 1:3184 GRAND CONCOURSE
Practice Address - Street 2:APT #LD
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1007
Practice Address - Country:US
Practice Address - Phone:718-584-0555
Practice Address - Fax:718-584-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00212579Medicaid
NY00212579Medicaid