Provider Demographics
NPI:1003978230
Name:CROWN MEDICAL PC
Entity Type:Organization
Organization Name:CROWN MEDICAL PC
Other - Org Name:ELI ROSEN MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSEROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-778-7272
Mailing Address - Street 1:358 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-4332
Mailing Address - Country:US
Mailing Address - Phone:718-778-7272
Mailing Address - Fax:718-773-4583
Practice Address - Street 1:358 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4332
Practice Address - Country:US
Practice Address - Phone:718-778-7272
Practice Address - Fax:718-773-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01859021Medicaid
NYA100000475Medicare PIN