Provider Demographics
NPI:1174715395
Name:BRONX MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:BRONX MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OKON
Authorized Official - Middle Name:E
Authorized Official - Last Name:UMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-537-3392
Mailing Address - Street 1:100 LINN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2503
Mailing Address - Country:US
Mailing Address - Phone:914-751-5900
Mailing Address - Fax:914-965-1974
Practice Address - Street 1:930 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2705
Practice Address - Country:US
Practice Address - Phone:718-537-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153743261QC1500X, 261QH0100X, 261QM1300X, 261QP2000X, 261QP2300X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00758190Medicaid
NY90D672OtherBCBS
NY=========OtherEMPIRE PLAN
NY=========OtherSIGNA
NY00758190Medicaid
=========OtherAFFINITY
NY90D672OtherBCBS
=========OtherUNITED HEALTH CARE
NY=========Other1199
NY=========OtherWELL PLAN
=========OtherEMPIRE PLAN
NY=========OtherHEALTH FIRST
=========OtherUNITED HEALTH CARE
NYB1988Medicare UPIN