Provider Demographics
NPI:1609279975
Name:BRONX PULMONARY MEDICAL,PLLC
Entity type:Organization
Organization Name:BRONX PULMONARY MEDICAL,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONROE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARETZKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-583-9249
Mailing Address - Street 1:441 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-4301
Mailing Address - Country:US
Mailing Address - Phone:718-583-9240
Mailing Address - Fax:718-299-6065
Practice Address - Street 1:441 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4301
Practice Address - Country:US
Practice Address - Phone:718-583-9240
Practice Address - Fax:718-299-6065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONROE KARETZKY, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-01
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00373831Medicaid
NY03227781Medicaid
NYA100001766Medicare PIN
NJC52548Medicare UPIN