Diabetes Relief Center of Bronx Mso LLC

NPI #1043738586 in Bronx, New York

Provider Information

NPI Number: 1043738586
Entity Type: Organization
Organization Name: Diabetes Relief Center of Bronx Mso LLC
Primary Specialty: Internal Medicine
Enumeration Date: Sep 5, 2017
Last Updated: Sep 5, 2017

Practice Location

Address: 2825 3RD AVE STE 200
City: Bronx
State: New York
ZIP Code: 10455-4066
Phone: (916) 550-1050

Authorized Official

Name: DEANE' WALLACE
Title: CREDENTIALING SPECIALIST
Phone: (916) 571-9041

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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