Provider Demographics
NPI:1902979651
Name:LINCON MEDICAL AND MENTAL CENTER
Entity Type:Organization
Organization Name:LINCON MEDICAL AND MENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:AYODEJI
Authorized Official - Middle Name:BODUNRIN
Authorized Official - Last Name:FAYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-579-5579
Mailing Address - Street 1:15 FRANCINE CT
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1201
Mailing Address - Country:US
Mailing Address - Phone:914-761-0362
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:LINCOLN MEDICAL AND MENTAL HEALTH CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5579
Practice Address - Fax:718-579-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119113282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access