Bronx Borough Medical Practice PC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

BRONX BOROUGH MEDICAL PRACTICE PC

Practice address

2494 Williamsbridge Rd
Bronx, NY 10469-4806

Phone

(914) 395-3691

NPI assigned

Dec 21, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mack Lee Sullivan

Title

Owner

Phone

(914) 395-3691

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1124590641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 WHITE PLAINS RD STE B",
            "city": "EASTCHESTER",
            "state": "NY",
            "postal_code": "107092805",
            "telephone_number": "914-395-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2494 WILLIAMSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104694806",
            "telephone_number": "914-395-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONX BOROUGH MEDICAL PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MACK",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "914-395-3691"
    },
    "taxonomies": [
        {
            "code": "207RS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "115019",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bronx Addiction Services Integrated Concepts System Inc
• Bronx Addiction Treatment Center
• Bronx AIDS Services
• Bronx Anesthesia Services, PC
• Bronx Baby Docs Pediatrics P.C.
• Bronx Cardiology, P.C
• Bronx Care Centerls LLC
• Bronx Care Medical PC
• Bronx Care Pharmacy Inc.
• Bronx Center for Rehabilitation and Health Care LLC

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.