Provider Demographics
NPI:1073557674
Name:BROOKLYN COMMUNITY MEDICAL PC
Entity Type:Organization
Organization Name:BROOKLYN COMMUNITY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANEGER
Authorized Official - Prefix:
Authorized Official - First Name:ABARAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-951-8800
Mailing Address - Street 1:2555 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4730
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2555 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4730
Practice Address - Country:US
Practice Address - Phone:718-951-8800
Practice Address - Fax:718-951-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223328174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45V542Medicare ID - Type Unspecified