Basic Information
| Provider Information | |||||||||
| NPI: | 1831304245 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRONX WESTCHESTER MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1521 JARRET PL | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185181276 | ||||||||
| FaxNumber: | 7185181281 | ||||||||
| Practice Location | |||||||||
| Address1: | 1521 JARRET PL | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185181276 | ||||||||
| FaxNumber: | 7185181281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAITMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7185181276 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 163283 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.