Provider Demographics
NPI:1235228719
Name:KINGSWAY INTERNAL MEDICINE
Entity Type:Organization
Organization Name:KINGSWAY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-891-1500
Mailing Address - Street 1:2525 BATCHELDER ST
Mailing Address - Street 2:1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1453
Mailing Address - Country:US
Mailing Address - Phone:718-891-1500
Mailing Address - Fax:718-891-2068
Practice Address - Street 1:2525 BATCHELDER ST
Practice Address - Street 2:1L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1453
Practice Address - Country:US
Practice Address - Phone:718-891-1500
Practice Address - Fax:718-891-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NY083819207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00125411Medicaid
NY00125411Medicaid
NYB88672Medicare UPIN