Bronxcare Dr. Martin Luther King Jr. Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

7000212R Issued in NY

Legal business name

BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER

Practice address

853 Tiffany Street
Bronx, NY 10459

Phone

(718) 901-8600

Fax

(718) 293-1475

NPI assigned

Mar 9, 2011

Last updated

May 31, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTERAs reported in NPPES

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

Authorized official

Name

Mr. Victor G Demarco, CPA

Title

Senior VP-Chief Financial Officer

Phone

(718) 901-8600

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bronx Care Tiffany Med&Ped Practice Other name

Part of

Martin L King HLTH Ctr

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bronxcare Dr. Martin Luther King Jr. Health Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
  • NPI 1437231693
  NPPES parent name

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527724800000",
    "number": "1528366937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1276 FULTON AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563402",
            "telephone_number": "718-901-8600",
            "fax_number": "718-293-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 TIFFANY STREET",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10459",
            "telephone_number": "718-901-8600",
            "fax_number": "718-293-1475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER",
        "enumeration_date": "2011-03-09",
        "last_updated": "2018-05-31",
        "status": "A",
        "authorized_official_last_name": "DEMARCO",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SENIOR VP-CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "718-901-8600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "7000212R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03410579",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "W0437",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bronx Care Tiffany Med&Ped Practice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Bronx Care Tiffany Med&Ped Practice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Bronxcare Health System

• Federally Qualified Health Center (FQHC) in Bronx, NY
• Providers in Bronx, NY by specialty
• Federally Qualified Health Center (FQHC) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.