Grand Concourse Health Wellness Medical, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

260048 Issued in NY

Legal business name

GRAND CONCOURSE HEALTH WELLNESS MEDICAL, PC

Practice address

2336 Grand Concourse
Bronx, NY 10458-6903

Phone

(718) 220-0439

Fax

(718) 220-0489

NPI assigned

Oct 31, 2012

Organization subpart

No

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

Authorized official

Name

Dmitry Ilyevsky, MD

Title

President

Phone

(718) 220-0439

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1811241631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104586903",
            "telephone_number": "718-220-0439",
            "fax_number": "718-220-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104586903",
            "telephone_number": "718-220-0439",
            "fax_number": "718-220-0489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND CONCOURSE HEALTH WELLNESS MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-31",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "ILYEVSKY",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-220-0439",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "260048",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "260048",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent Gramuglia, DPM
• Marly Grana, M.D.
• Nitza Granados
• Antun Grancaric, PA-C
• Grand Concourse Bronx Eye Care Inc
• Grand Concourse Medical Practice, P.C.
• Grand Concourse Pharmacy Inc
• Grand Drugs Inc
• Grand Manor Health Related Facility Inc.
• Grand Manor Nursing Home

• Internal Medicine Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2012; 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.