Provider Demographics
NPI:1235204447
Name:BE HEALTHY MEDICAL PC
Entity Type:Organization
Organization Name:BE HEALTHY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-648-2122
Mailing Address - Street 1:1302 KINGS HWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1960
Mailing Address - Country:US
Mailing Address - Phone:718-645-2700
Mailing Address - Fax:718-645-3188
Practice Address - Street 1:1302 KINGS HWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1960
Practice Address - Country:US
Practice Address - Phone:718-645-2700
Practice Address - Fax:718-645-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211343207R00000X
213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBE0WBW2210Medicare ID - Type UnspecifiedGROUP MEDICARE ID