Provider Demographics
NPI:1326699117
Name:BROOKLYN MEDICAL SERVICES OF NY
Entity Type:Organization
Organization Name:BROOKLYN MEDICAL SERVICES OF NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GORUM
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:718-339-7500
Mailing Address - Street 1:1575 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7203
Mailing Address - Country:US
Mailing Address - Phone:718-339-7500
Mailing Address - Fax:718-228-6485
Practice Address - Street 1:1575 E 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7203
Practice Address - Country:US
Practice Address - Phone:718-339-7500
Practice Address - Fax:718-228-6485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6659OtherAAAASF