CCN GENERAL MEDICINE PLLC NPI 1902120025

NPI Information

NPI: 1902120025
Provider Name: CCN GENERAL MEDICINE PLLC
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
CLIA Number: 33D2009552
Address: 1262 BOSTON RD
SUITE 2
BRONX, NY
ZIP 10456
Phone: (718) 569-7929

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NPI Details

CCN GENERAL MEDICINE PLLC is a primary care clinic center in Bronx, NY. CCN GENERAL MEDICINE PLLC NPI is 1902120025. The provider is registered as an organization entity type.

The provider's business location address is:

1262 BOSTON RD
SUITE 2
BRONX, NY
ZIP 10456-602
Phone: (718) 569-7929
Fax: (347) 590-5482

The provider's authorized official is Cecilia G Calderon .
The authorized official title is Medical Director and has the following contact phone number (718) 569-7929.

The CLIA number assigned to this NPI record is 33D2009552 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/18/2010 and was last updated on 6/19/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	255626	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	02932589	MEDICAID	NEW YORK
2	1427118140	OTHER	NEW YORK	NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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