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BRONXCARE DENTAL SERVICES
NPI 1619275039
Clinic/Center - Federally Qualified Health Center (FQHC) in Bronx, NY

Active since March 09, 2011CLIA 33D0006588 · Waiver
1775 GRAND CONCOURSE, BRONX, NY 10453(718) 901-8600(718) 293-1475 Get Directions Write a Review

NPPES record last updated: June 28, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Bronxcare Dental Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRONXCARE DENTAL SERVICES (NPI 1619275039) is a healthcare organization registered as a federally qualified health center (fqhc) in Bronx, New York and active in the NPI registry since March 2011. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Victor G Demarco, Senior Vp-chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1619275039
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameBRONXCARE DR. MARTIN LUTHER KING JR. HEALTH CENTER
Location Address1775 GRAND CONCOURSEBronx, NY 10453
Mailing Address1276 Fulton AveBronx, NY 10456-3402 · (718) 901-8600 · Fax (718) 293-1475
Phone(718) 901-8600
Fax(718) 293-1475
Organization SubpartYesParent: Bronxcare Dr. Martin Luther King Jr Health Center Inc
Authorized OfficialVictor G DemarcoSenior Vp-chief Financial Officer · (718) 901-8600
Enumeration DateMarch 9, 2011
Last NPPES UpdateJune 28, 2018
✔ NPI 1619275039 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
License✔ Licensed in NY · 7000212R
1775 GRAND CONCOURSE, Bronx, NY 10453
Open in Google Maps ↗

Other Names 1

Doing Business AsBronxcare Dental Services

Other Identifiers 2

OtherW0437NY · Blue Cross
Medicaid03410919NY

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bronxcare Dental Services is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateNew YorkEnrollment IDO20110329000750Part A · Federally Qualified Health Center (FQHC)Due dateMarch 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0006588

Bronxcare Hospital Center · Bronx, NY
Active · expires Mar 26, 2027
CLIA Number33D0006588
Laboratory TypeHospital
Certificate Effective DateOctober 2, 2003
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Aam A. Baqui
Laboratory Phone(718) 518-5204
Laboratory LocationBronxcare Hospital Center1276 Fulton Avenue, Bronx, NY 10456
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CANDACE WARRICK DPT
Physical Therapist
1775 GRAND CONCOURSE, BRONX-LEBANON HOSP CTR. DEPT PM & R
BRONX, NY 10453
Bronx County (718) 579-3940
KHRYSTYNA LESKIV D.D.S.
Dentist (Pediatric Dentistry)
1775 GRAND CONCOURSE
BRONX, NY 10453
Bronx County (718) 992-7669
GIOVANNI WILLIAMS
Community Health Worker
1775 GRAND CONCOURSE
BRONX, NY 10453
Bronx County (914) 591-7300
NEIL M PADILLA PT
Physical Therapist
1775 GRAND CONCOURSE
BRONX, NY 10453
Bronx County (718) 579-3940
RONNIE SESSO
Community Health Worker
1775 GRAND CONCOURSE
BRONX, NY 10453
Bronx County (914) 591-7300
DR. UNNATI SONI DMD
Student in an Organized Health Care Education/Training Program
1775 GRAND CONCOURSE
BRONX, NY 10453
Bronx County (718) 901-8400
TASHORN GOMEZ DDS
Dentist (Oral and Maxillofacial Surgery)
1775 GRAND CONCOURSE, 6TH FLOOR
BRONX, NY 10453
Bronx County (718) 901-8110
JENNIFER AROCHA
Case Manager/Care Coordinator
1775 GRAND CONCOURSE
BRONX, NY 10453
Bronx County (718) 733-6100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bronxcare Dr. Martin Luther King Jr. Health Center's NPI number?

The NPI number for Bronxcare Dr. Martin Luther King Jr. Health Center is 1619275039. It was assigned to this organization in the NPPES registry on March 9, 2011. The provider is doing business as Bronxcare Dental Services.

Where is Bronxcare Dr. Martin Luther King Jr. Health Center located?

Bronxcare Dr. Martin Luther King Jr. Health Center is located at 1775 Grand Concourse, Bronx, NY 10453. The listed phone number is (718) 901-8600.

What is Bronxcare Dr. Martin Luther King Jr. Health Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Bronxcare Dr. Martin Luther King Jr. Health Center enrolled in Medicare?

Yes. Bronxcare Dr. Martin Luther King Jr. Health Center is registered in the Medicare PECOS enrollment system.

When is Bronxcare Dr. Martin Luther King Jr. Health Center's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (New York, Federally Qualified Health Center (FQHC)) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Bronxcare Dr. Martin Luther King Jr. Health Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D0006588) is associated with this NPI, valid through March 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bronxcare Dr. Martin Luther King Jr. Health Center was last updated on June 28, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.