BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE – NPI #1588962906
Clinic/Center

BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE is an AHC clinic located in BRONX, NY. NPPES has assigned the NPI number 1588962906 to BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE on March 09, 2011. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE” is a dba name, the actual legal business name for this organization is BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER. The primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 3 years ago on Oct 19, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE below.

NPI Profile for
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER

NPI Number
1588962906
Enumeration Date

(more than 15 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Doing Business As (dba): BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE
Primary location
2739-2745 3RD AVENUE
BRONX, NY 10451
Phone: (718) 901-8600 Fax: (718) 293-1475
Mailing address
1276 FULTON AVE
BRONX, NY 10456-3402
Phone: (718) 901-8600 Fax: (718) 293-1475
Organization Subpart
Yes - BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE is subpart of another organization.
Authorized Official
VICTOR DEMARCO
SENIOR VP-CHIEF FINANCIAL OFFICER
Phone: (718) 901-8600
Updated
Certification Date
Oct 18, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for BRONXCARE THIRD AVENUE MEDICAL & DENTAL PRACTICE

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
otherBLUE CROSSNYW0437
medicaidNY03410588
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)
NY 7000212R

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.