Provider Demographics
NPI:1134286081
Name:BRIGHTON COMMUNITY MEDICAL P.C.
Entity Type:Organization
Organization Name:BRIGHTON COMMUNITY MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-646-5500
Mailing Address - Street 1:330 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6846
Mailing Address - Country:US
Mailing Address - Phone:718-646-5500
Mailing Address - Fax:718-646-1975
Practice Address - Street 1:330 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6846
Practice Address - Country:US
Practice Address - Phone:718-646-5500
Practice Address - Fax:718-646-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013288302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02018293Medicaid
NYQ41931Medicare ID - Type Unspecified