1548430325 NPI number — BROOKLYN MEDICAL HEALTH & WELLNESS, P.C.

Table of content: (NPI 1548430325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548430325 NPI number — BROOKLYN MEDICAL HEALTH & WELLNESS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLYN MEDICAL HEALTH & WELLNESS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548430325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 670618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11367-0618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-686-7564
Provider Business Mailing Address Fax Number:
718-261-7606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3043 OCEAN AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-3497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-7772
Provider Business Practice Location Address Fax Number:
718-332-5329
Provider Enumeration Date:
03/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAUMGARTEN
Authorized Official First Name:
JACK
Authorized Official Middle Name:
LEONARD
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
917-686-7564

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  206669 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com