Provider Demographics
NPI:1306839931
Name:CROSS COUNTY MEDICAL PC
Entity Type:Organization
Organization Name:CROSS COUNTY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:AZRIEL
Authorized Official - Last Name:CHARNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-859-5843
Mailing Address - Street 1:1262 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5102
Mailing Address - Country:US
Mailing Address - Phone:718-859-5843
Mailing Address - Fax:718-859-6284
Practice Address - Street 1:1262 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5102
Practice Address - Country:US
Practice Address - Phone:718-859-5843
Practice Address - Fax:718-859-6284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5506981OtherGHI
5506981OtherGHI