1649630682 NPI number — BROOKLYN URGENT CARE OF BORO PARK PLLC

Table of content: SHIAO YEN KHOO MD (NPI 1760613186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649630682 NPI number — BROOKLYN URGENT CARE OF BORO PARK PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLYN URGENT CARE OF BORO PARK PLLC
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:
1649630682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1318 42ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11219-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-436-2496
Provider Business Mailing Address Fax Number:
718-972-5404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3909 13TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11218-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-436-2496
Provider Business Practice Location Address Fax Number:
718-972-5404
Provider Enumeration Date:
03/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MOSKOWITZ
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
718-436-2496

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , 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 © 2007-2025 www.npivalidator.com