Basic Information
| Provider Information | |||||||||
| NPI: | 1528232923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI CENTER - BRONX | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | STE 417 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | 7185848395 | ||||||||
| Practice Location | |||||||||
| Address1: | 2488 GRAND CONCOURSE | ||||||||
| Address2: | STE 417 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | 7185848395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | DEBORAH MANNERS-GREENE | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7185847204 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW, CASAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0401X | 080711466 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
No ID Information.