Provider Demographics
NPI:1003225038
Name:FLATBUSH MEDICAL PLAZA, P.C.
Entity Type:Organization
Organization Name:FLATBUSH MEDICAL PLAZA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHTENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN
Authorized Official - Phone:917-966-2700
Mailing Address - Street 1:1468 FLATBUSH AVE.
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210
Mailing Address - Country:US
Mailing Address - Phone:917-966-2700
Mailing Address - Fax:917-966-2703
Practice Address - Street 1:1468 FLATBUSH AVE.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210
Practice Address - Country:US
Practice Address - Phone:917-966-2700
Practice Address - Fax:917-966-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218261261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY218261OtherLICENCE
NY02090619Medicaid
NJ25MA07870200OtherLICENCE