Basic Information
| Provider Information | |||||||||
| NPI: | 1649437021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRONXLEBAON HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1770 GRAND CONCOURSE | ||||||||
| Address2: | DEP 5L1 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104575524 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 1770 GRAND CONCOURSE | ||||||||
| Address2: | DEP 5L1 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104575524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189018294 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | VASQUEZ | ||||||||
| AuthorizedOfficialFirstName: | MARIO | ||||||||
| AuthorizedOfficialMiddleName: | LUIS | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7189018294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.