Provider Demographics
NPI:1093902108
Name:THE MEDICAL PRACTICE OF BROOKLYN PC
Entity Type:Organization
Organization Name:THE MEDICAL PRACTICE OF BROOKLYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BAKOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-621-7100
Mailing Address - Street 1:2165 71ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5526
Mailing Address - Country:US
Mailing Address - Phone:718-621-7100
Mailing Address - Fax:
Practice Address - Street 1:2165 71ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5526
Practice Address - Country:US
Practice Address - Phone:718-621-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty