Provider Demographics
NPI:1053526509
Name:BRONX PARK REHABILITATION & SPORTS MEDICINE PC
Entity type:Organization
Organization Name:BRONX PARK REHABILITATION & SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKKAPEDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-430-7605
Mailing Address - Street 1:2016 BRONXDALE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3388
Mailing Address - Country:US
Mailing Address - Phone:718-918-9702
Mailing Address - Fax:845-942-8623
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:718-918-9702
Practice Address - Fax:845-942-8623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22Z231Medicare PIN