BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER (NPI# 1619275039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619275039 |
| Entity Type | Organization |
| Organization Name | BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER |
| Other Organization Name | BRONXCARE DENTAL SERVICES |
| Practice Address |
1775 Grand Concourse Bronx NY 10453 |
| Mailing Address |
1276 Fulton Ave Bronx NY 10456-3402 |
| Practice Telephone | 7189018600 |
| Practice Fax Number | 7182931475 |
| Mailing Telephone | 7189018600 |
| Mailing Fax Number | 7182931475 |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2018-06-28 |
| Authorized Official Name | MR. VICTOR G DEMARCO (SENIOR VP-CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7189018600 |
| Authorized Official Credential | CPA |
| Is Organization Subpart | Y |
| Parent Organization Name | BRONXCARE DR. MARTIN LUTHER KING JR HEALTH CENTER INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
7000212R | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | BLUE CROSS | W0437 | 01 |
| NY | 03410919 | 05 |
| Other Name | Type Code |
|---|---|
| BronxCare Dental Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043518467 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 1591 Fulton Avenue, Bronx, NY 10457 | 2011-03-09 |
| 1073811485 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 1690 Bryant Avenue, Bronx, NY 10460 | 2011-03-09 |
| 1528366937 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 853 Tiffany Street, Bronx, NY 10459 | 2011-03-09 |
| 1588962906 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 2737-2741 3rd Avenue, Bronx, NY 10451 | 2011-03-09 |
| 1376898908 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 321 E Tremont Ave, Bronx, NY 10457 | 2012-07-19 |
| 1740558568 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 1067 Ogden Ave, Bronx, NY 10452 | 2011-12-07 |
| 1700184116 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 2432 Grand Concourse, Bronx, NY 10458 | 2011-03-09 |
| 1437231693 | Bronxcare Dr. Martin Luther King Jr. Health Center | Clinic/Center | 1265 Franklin Ave, Bronx, NY 10456 | 2006-10-19 |
| Street Address |
1775 GRAND CONCOURSE |
| City | BRONX |
| State | NY |
| Zip Code | 10453 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003916545 | Candace Warrick | Physical Therapist | 1775 Grand Concourse, Bronx-lebanon Hosp Ctr. Dept Pm & R, Bronx, NY 10453-8202 | 2006-09-24 |
| 1366066151 | Hyunjung Shin | Student in an Organized Health Care Education/Training Program | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2020-06-08 |
| 1730703265 | Obianuju Okeke | Student in an Organized Health Care Education/Training Program | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2020-06-01 |
| 1780207993 | Jennifer Suji Kim | Student in an Organized Health Care Education/Training Program | 1775 Grand Concourse, Bronxcare Health Systems, Dept of Dentistry, 6th Floor, Bronx, NY 10453 | 2020-05-21 |
| 1427698943 | Jeffery Harper | Counselor | 1775 Grand Concourse, Bronx, NY 10000 | 2020-01-13 |
| 1528606266 | Michael Whitley | Registered Nurse | 1775 Grand Concourse, Pgcmh 8th Fl Nursing, Bronx, NY 10453-8202 | 2019-12-12 |
| 1972148054 | Bert Benjamin | Community Health Worker | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2019-11-12 |
| 1881239960 | Evelyn Carranza | Community Health Worker | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2019-11-12 |
| 1699310771 | Jamie Danyko | Community Health Worker | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2019-11-12 |
| 1508401688 | Jacqueline Green | Community Health Worker | 1775 Grand Concourse, Bronx, NY 10453-8202 | 2019-11-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316553225 | Victor Felipe | Occupational Therapist | 2042 Grand Avenue, Apartment 2d, Ny, Apt 2d, Bronx, NY 10453 | 2020-09-17 |
| 1033745849 | Jennifer Vargas | Student in an Organized Health Care Education/Training Program | Bronxcare Health Systems Dept of Dentistry, 1775 Grand Concourse 6th Floor, Bronx, NY 10453 | 2020-03-13 |
| 1457985038 | John Steven Contreras | Student in an Organized Health Care Education/Training Program | Bronxcare Health Systems, Dept of Dentistry, 1775 Grand Concourse 6th Floor, Bronx, NY 10453 | 2020-02-24 |
| 1538799648 | Ari Warshawsky | Counselor | Postgraduate Center for Mental Health, 1775 Grand Concourse, 8th Floor, Bronx, NY 10453 | 2020-01-17 |
| 1407403413 | Cristaly Williams | Behavioral Analyst | 2105 Jerome Avenue, Bronx, NY 10453 | 2019-08-23 |
| 1770041204 | Yei Won Lee | Student in an Organized Health Care Education/Training Program | Bronxcare Health Systems, Dental Dept, 1775 Grand Concourse, 6th Floor, Bronx, NY 10453 | 2019-03-04 |
| 1265905517 | William Alexander Jones Jr. | Behavior Technician | 1749grand Concourse, 1749 Grand Concourse Apt Ph8, Bronx, NY 10453 | 2019-01-09 |
| 1154810737 | Emily Patricia Mitchell | Occupational Therapist | 2105 Jerome Ave, Bronx, NY 10453 | 2018-05-09 |
| 1417445149 | Ashna N Shah | Student in an Organized Health Care Education/Training Program | Bronx Lebanon Hospital Center 6 Th Floor, 1775 Grand Concourse, Bronx, NY 10453 | 2018-04-27 |
| 1700384328 | Kevin Ponce Obate | Physical Therapist | 1975 University Ave, Bronx, NY 10453 | 2018-01-29 |
| Find all providers in zip 10453 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
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| 1881177533 | Hudson River Healthcare, Inc. | Clinic/Center | 459 East 149th Street, The Hub Health Center, Bronx, NY 10455-1314 | 2018-09-10 |
| 1720561517 | Hudson River Healthcare, Inc. | Clinic/Center | 226 East 144th Street, Brightpoint Health Citiwide, Bronx, NY 10451-5909 | 2018-09-08 |
| 1023503927 | Urban Health Plan, Inc. | Clinic/Center | 1000 Jennings St, Bronx, NY 10460-6099 | 2018-06-25 |
| 1669912341 | Morris Heights Health Center, Inc. | Clinic/Center | 1227 Edward L Grant Hwy, Bronx Medical and Wellness Center, Bronx, NY 10452-3101 | 2017-03-01 |
| 1104374685 | Morris Heights Health Center, Inc. | Clinic/Center | 825 E 233rd St, Bronx, NY 10466-3203 | 2016-09-14 |
| 1790154466 | Damian Family Care Centers, Inc. | Clinic/Center | 2604 3rd Avenue, Bronx, NY 10454 | 2015-09-23 |
| 1659754885 | Union Community Health Center, Inc. | Clinic/Center | 2101 Quarry Road, Bronx, NY 10457-2594 | 2015-07-07 |
| 1740679695 | Care for The Homeless | Clinic/Center | 800 Barretto St, Bronx, NY 10474-5304 | 2015-01-15 |
| Find all providers in BRONX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.