Provider Demographics
NPI:1487191953
Name:KBJ MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:KBJ MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS SYLVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-842-3552
Mailing Address - Street 1:3225 FENTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-2801
Mailing Address - Country:US
Mailing Address - Phone:718-547-0741
Mailing Address - Fax:
Practice Address - Street 1:407 ROCKAWAY AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5635
Practice Address - Country:US
Practice Address - Phone:718-644-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272090207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty