| Concourse West Management Inc | |
|
880 River Ave Bronx NY 10452-9431 | |
| (718) 992-0410 | |
| (718) 538-4323 |
| Full Name | Concourse West Management Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 880 River Ave, Bronx, New York |
| Authorized Official Name and Position | Shel S Kupper (OWNER) |
| Authorized Official Contact | 7189920410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Concourse West Management Inc 880 River Ave Bronx NY 10452-9431 Ph: (718) 992-0410 | Concourse West Management Inc 880 River Ave Bronx NY 10452-9431 Ph: (718) 992-0410 |
| NPI Number | 1588749881 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588749881 | NPI | - | NPPES |
| 01762532 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 050404 (New York) | Primary |
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